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Elshafie BE, Elsanosi MSA, El Amin A, Butcher R, Willis R, Bakhtiari A, Jimenez C, Dejene M, Solomon AW, Harding-Esch EM, Binnawi KH. Trachoma Prevalence in Four Localities of Darfur Region, Sudan, following One Round of Antibiotic Mass Drug Administration. Ophthalmic Epidemiol 2023; 30:571-579. [PMID: 34423732 PMCID: PMC10581671 DOI: 10.1080/09286586.2021.1953538] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 06/29/2021] [Accepted: 07/02/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The prevalence of trachomatous inflammation-follicular (TF) in 1-9-year-olds and of trachomatous trichiasis (TT) in ≥15-year-olds in four endemic evaluation units (EUs) of Darfur region, Sudan, was measured more than a year after the required single round of antibiotic mass drug administration (MDA). METHODS Surveys were conducted using highly standardised, World Health Organization-recommended methodologies. Individuals aged ≥1 year, resident in selected households, were chosen for the survey using a two-stage cluster sampling process. Consenting adults and children were examined for the signs TF and TT by graders trained to international standards. Prevalence of disease in key indicator groups was calculated and weighted to the underlying population structure. RESULTS A mean of 1,415 (range: 1,253-1,611) children aged 1-9 years were examined in each EU. The age-adjusted prevalence of TF in 1-9-year-olds in each of the four surveyed EUs was <5%. A mean of 1,139 people aged ≥15 years (range: 1,080-1,201) were examined in each EU. The estimated age- and gender-adjusted prevalence of TT in ≥15-year-olds was <0.2% in all four EUs. In general, the proportion of households with access to improved WASH facilities was generally lower in this study than in corresponding baseline studies. CONCLUSIONS No further MDA should be conducted in these four EUs for the next 2 years, at which point they should be re-surveyed to determine whether the prevalence of TF in 1-9-year-olds has remained <5%. Active TT case-finding is also not indicated. Environmental improvement and promotion of facial cleanliness measures should continue to be implemented to prevent disease recrudescence.
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Affiliation(s)
| | | | - Atif El Amin
- Sudan National Trachoma Control Programme, Khartoum, Sudan
| | - Robert Butcher
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | | | | | - Anthony W Solomon
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Emma M Harding-Esch
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
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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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Gallini JW, Sata E, Zerihun M, Melak B, Haile M, Zeru T, Gessese D, Ayele Z, Tadesse Z, Callahan EK, Nash SD, Weiss PS. Optimizing cluster survey designs for estimating trachomatous inflammation-follicular within trachoma control programs. Int J Infect Dis 2021; 116:101-107. [PMID: 34965463 DOI: 10.1016/j.ijid.2021.12.355] [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: 09/23/2021] [Revised: 12/21/2021] [Accepted: 12/22/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES The World Health Organization recommends mass drug administration (MDA) with azithromycin to eliminate trachoma as a public health problem. MDA decisions are based on prevalence estimates from two-stage cluster surveys. Work remains to mathematically evaluate current trachoma survey designs. We aimed to characterize the effects of the number of units sampled on the precision and cost of trachomatous inflammation-follicular (TF) estimates. METHODS We simulated a population of 30 districts to represent the breadth of possible TF distributions in Amhara, Ethiopia. Samples of varying numbers of clusters (14-34) and households (10-60) were selected. Sampling schemes were evaluated on precision, proportion of incorrect and low MDA decisions made, and estimated cost. RESULTS Number of clusters sampled had a greater impact on precision than number of households. The most efficient scheme depended on the underlying TF prevalence in a district. For lower prevalence areas (<10%) the most cost efficient (providing adequate precision while minimizing cost) design was 20 clusters of 20-30 households. For higher prevalence areas (>10%), the most efficient design was 15-20 clusters of 20-30 households. CONCLUSIONS For longer-running programs, using context-specific survey designs would allow for practical precision while reducing survey costs. Sampling 15 clusters of 20-30 households in suspected moderate to high prevalence districts and 20 clusters of 20-30 households in districts suspected to be near the 5% threshold appears to be a balanced approach.
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Affiliation(s)
- Julia W Gallini
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia, USA
| | - Eshetu Sata
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Mulat Zerihun
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Berhanu Melak
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Mahteme Haile
- Amhara Public Health Institute, Bahir Dar, Amhara, Ethiopia
| | - Taye Zeru
- Amhara Public Health Institute, Bahir Dar, Amhara, Ethiopia
| | - Demelash Gessese
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Zebene Ayele
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Zerihun Tadesse
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - E Kelly Callahan
- Trachoma Control Program, The Carter Center, Atlanta, Georgia, USA
| | - Scott D Nash
- Trachoma Control Program, The Carter Center, Atlanta, Georgia, USA.
| | - Paul S Weiss
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia, USA
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Xiong T, Yue Y, Li WX, Choonara I, Qazi S, Chen HJ, Tang J, Shi J, Wang H, Zeng LN, Xia B, Qiao LN, Qu Y, Mu DZ. Effectiveness of azithromycin mass drug administration on trachoma: a systematic review. Chin Med J (Engl) 2021; 134:2944-2953. [PMID: 34665571 PMCID: PMC8710348 DOI: 10.1097/cm9.0000000000001717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUNDS Azithromycin mass drug administration (MDA) is a key part of the strategy for controlling trachoma. This systematic review aimed to comprehensively summarize the present studies of azithromycin MDA on trachoma; provide an overview of the impact of azithromycin MDA on trachoma in different districts; and explore the possible methods to enhance the effectiveness of azithromycin MDA in hyperendemic districts. METHODS PubMed, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, and ClinicalTrials.gov were searched up to February 2021 with no language restriction. Studies reporting the effect of azithromycin MDA on trachoma were included. Mathematical modeling studies, animal studies, case reports, and reviews were excluded. The trachomatous inflammation-follicular (TF) <5.0% was used to judge the effect of azithromycin MDA on eliminating trachoma as a public health problem. Two researchers independently conducted the selection process and risk of bias assessment. RESULTS A total of 1543 studies were screened, of which 67 studies including 13 cluster-randomized controlled trials and 54 non-randomized studies were included. The effect of azithromycin MDA on trachoma was closely related to the baseline prevalence in districts. For the districts with baseline prevalence between 5.0% and 9.9%, a single round of MDA achieved a TF <5.0%. For the districts with baseline between 10.0% and 29.9%, annual MDA for 3 to 5 years reduced TF <5.0%. However, for the districts with high level of baseline prevalence (TF >30.0%), especially with baseline TF >50.0%, annual MDA was unable to achieve the TF <5.0% even after 5 to 7 years of treatment. Quarterly MDA is more effective in controlling trachoma in these hyperendemic districts. CONCLUSIONS Azithromycin MDA for controlling trachoma depends on the baseline prevalence. The recommendation by the World Health Organization that annual MDA for 3 to 5 years in the districts with TF baseline >10.0% is not appropriate for all eligible districts.
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Affiliation(s)
- Tao Xiong
- Department of Pediatrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Yan Yue
- Key Laboratory of Obstetrics & Gynecologic and Pediatric Diseases and Birth Defects of the Ministry of Education, Sichuan University, Chengdu, Sichuan 610041, China
| | - Wen-Xing Li
- Department of Pediatrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Imti Choonara
- Academic Division of Child Health, University of Nottingham, Derbyshire Children's Hospital, Derby, UK
| | - Shamim Qazi
- Department of Maternal Newborn Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Hong-Ju Chen
- Department of Pediatrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Jun Tang
- Department of Pediatrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Jing Shi
- Department of Pediatrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Hua Wang
- Department of Pediatrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Li-Nan Zeng
- Department of Pharmacy, Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, Chengdu, Sichuan 610041, China
| | - Bin Xia
- Department of Pediatrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Li-Na Qiao
- Department of Pediatrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Yi Qu
- Department of Pediatrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - De-Zhi Mu
- Key Laboratory of Obstetrics & Gynecologic and Pediatric Diseases and Birth Defects of the Ministry of Education, Sichuan University, Chengdu, Sichuan 610041, China
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Gammoh Y, Abdu M. Contact lens procurement and usage habits among adults in Sudan. PLoS One 2021; 16:e0251987. [PMID: 34010356 PMCID: PMC8133405 DOI: 10.1371/journal.pone.0251987] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 05/06/2021] [Indexed: 02/03/2023] Open
Abstract
Objective The study aimed to assess contact lens (CL) wear and care habits among adults in Sudan. Design An observational, non-interventional, multi-center, cross-sectional study was conducted in the CL departments of all the eye hospitals and centers, and optical centers in the Khartoum State, Sudan. Participants Established CL wearers residing in Khartoum State, Sudan. Main outcomes and measures CL wear profile, CL usage habits, hand and CL hygiene habits were assessed using an interviewer-administered questionnaire. Results The average age of the 442 participants was 24.57 (± 4.87) years. Women comprised 92% of the sample. Smoking was reported by 15.8% of the sample. 81.9% wore soft spherical CL, with 43.4% of the participants were prescribed CL on a yearly replacement schedule. Only 68.3% were prescribed CL by an eye care practitioner. Multipurpose solutions were used by 78.8% of the sample to clean CL, and by 52% to clean the lens case. Compliance rate for CL wear and care among participants was 81.1%. None of the participants reported sharing CL or CL case and rinsing the case with tap water. High compliance level was observed for overnight wear; swimming and showering with CL; handwashing before CL insertion; and cleaning of CL. Moderate compliance rates were recorded for cleaning and replacing lens case, and topping up or sharing solution. Low compliance was noted for attending after care visits. Conclusions and relevance CL wearers in Sudan exhibit high to moderate levels of compliance to most contact lens wear and care aspects, except for attending aftercare visits. CL practitioners in Sudan are encouraged to prescribe CL appropriate to the lifestyle and economic situation of patients and actively recommend care products. In addition, practitioners need to follow up with patients to attend aftercare appointments, where hygienic wear and care habits should be emphasized.
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Affiliation(s)
- Yazan Gammoh
- Faculty of Allied Medical Sciences, Department of Optometry Science, Al-Ahliyya Amman University, Amman, Jordan
- * E-mail:
| | - Mustafa Abdu
- Faculty of Optometry and Visual Sciences, Department of Contact Lenses, Al-Neelain University, Khartoum, Sudan
- Faculty of Applied Medical Sciences, Department of Optometry, University of Jeddah, Jeddah, KSA
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Astale T, Ebert CD, Nute AW, Zerihun M, Gessese D, Melak B, Sata E, Ayele Z, Ayenew G, Callahan EK, Haile M, Zeru T, Tadesse Z, Nash SD. The population-based prevalence of trachomatous scarring in a trachoma hyperendemic setting: results from 152 impact surveys in Amhara, Ethiopia. BMC Ophthalmol 2021; 21:213. [PMID: 33985443 PMCID: PMC8120834 DOI: 10.1186/s12886-021-01972-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 04/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Trachomatous scarring (TS) results from repeated infection with the bacterium Chlamydia trachomatis. Pronounced scarring is an underlying cause of trachomatous trichiasis (TT) that can lead to blindness. Since the condition is irreversible, TS in adults has been considered a marker of past exposure to trachoma infection. The aim of this report was to estimate the population-based prevalence of TS within Amhara, Ethiopia, a region with a historically high burden of trachoma. METHODS District-level multi-stage cluster surveys were conducted in all districts between 2010 and 2015 to monitor the impact of approximately 5 years of trachoma interventions. Approximately 40 households were sampled per cluster and all participants ages ≥ 1 year were graded for the 5 World Health Organization simplified signs. Before each survey round, trachoma graders participated in a 7-day training and reliability exam that included cases of TS. TS prevalence estimates were weighted to account for sampling design and adjusted for age and sex using post-stratification weighting. RESULTS Across the 152 districts in Amhara, 208,510 individuals ages 1 year and older were examined for the signs of trachoma. Region-wide, the prevalence of TS was 8.2 %, (95 % Confidence Interval [CI]: 7.7-8.6 %), and the prevalence among individuals ages 15 years and older (n = 110,137) was 12.6 % (95 % CI: 12.0-13.3 %). District-level TS prevalence among individuals ages 15 years and older ranged from 0.9 to 36.9 % and was moderately correlated with district prevalence of TT (r = 0.31; P < 0.001). The prevalence of TS increased with age, reaching 22.4 % among those ages 56 to 60 years and 24.2 % among those ages 61 to 65 years. Among children ages 1 to 15 years TS prevalence was 2.2 % (95 % CI: 1.8-2.8 %), increased with age (P < 0.001), and 5 % of individuals with TS also had trachomatous inflammation-intense (TI). CONCLUSIONS These results suggest that Amhara has had a long history of trachoma exposure and that a large population remains at risk for developing TT. It is promising, however, that children, many born after interventions began, have low levels of TS compared to other known trachoma-hyperendemic areas.
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Affiliation(s)
| | - Caleb D Ebert
- F.I. Proctor Foundation, University of California, San Francisco, CA, San Francisco, USA.
| | | | | | | | | | | | | | | | | | | | - Taye Zeru
- Amhara Public Health Institute, Bahir Dar, Ethiopia
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Sanders AM, Adam M, Aziz N, Callahan EK, Elshafie BE. Piloting a trachomatous trichiasis patient case-searching approach in two localities of Sudan. Trans R Soc Trop Med Hyg 2020; 114:561-565. [PMID: 32307543 PMCID: PMC7405172 DOI: 10.1093/trstmh/traa022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 02/10/2020] [Accepted: 03/13/2020] [Indexed: 11/16/2022] Open
Abstract
Background Approximately 1.9 million people have become blind or visually impaired from trachoma, the leading cause of infectious blindness. Trachoma prevalence surveys conducted in Sudan have shown that thousands of Sudanese suffer from the advanced stages of the disease, trachomatous trichiasis (TT), and warrant sight-saving surgery. Sudan’s National Trachoma Control Program (NTCP) provides free TT surgery; however, given that many TT patients live in remote areas with limited access to health services, identifying patients and providing eye care services has proved challenging. For this reason, the Sudan NTCP piloted a systematic TT case-finding approach to identify patients. Methods In Gedarif state, 11 villages in Baladyat el Gedarif locality and 21 villages in West Galabat locality were included in a TT case-searching activity from September to November 2018. TT case finders were selected from the villages where the activity took place and were trained by ophthalmic medical assistants to identify possible patients. Results Of 66 626 villagers examined, 491 were identified as having TT by TT case finders. Of those, 369 were confirmed as true cases by the TT surgeons, a 75.2% (369/491) success rate. Conclusions The TT case-finding approach provides an example of an effective method for identifying TT patients and should be expanded to other parts of the country known to be endemic for trachoma.
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Affiliation(s)
| | | | | | | | - Belgesa E Elshafie
- National Program for Prevention of Blindness, Federal Ministry of Health, Khartoum, Sudan
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Oldenburg CE. One Size Does Not Fit All: Achieving Trachoma Control by 2030. Am J Trop Med Hyg 2020; 101:1189-1190. [PMID: 31595872 PMCID: PMC6896881 DOI: 10.4269/ajtmh.19-0684] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Catherine E Oldenburg
- Francis I Proctor Foundation Department of Ophthalmology and Epidemiology and Biostatistics, University of California, San Francisco, California
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