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Greenland K, Collin C, Sinba Etu E, Guye M, Hika D, Macleod D, Schmidt WP, Shafi Abdurahman O, Last A, Burton MJ. Comparison of metrics for assessing face washing behaviour for trachoma control. PLoS Negl Trop Dis 2024; 18:e0012399. [PMID: 39141680 PMCID: PMC11346966 DOI: 10.1371/journal.pntd.0012399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 08/26/2024] [Accepted: 07/24/2024] [Indexed: 08/16/2024] Open
Abstract
There is currently no single, easy-to-use, reliable indicator to assess whether a face has been washed with soap in the context of trachoma elimination. This study aimed to compare survey report, script-based pictorial recall and facial cleanliness indicators as alternatives to structured observation for measuring face washing behaviour. This method validation study was nested in the Stronger-SAFE trial, Oromia Region, Ethiopia. Structured observation was conducted in randomly selected households for three hours from dawn. The primary caregiver in each household participated in a survey to capture (self)-reported behaviour and/or script-based pictorial recall, a routine-based diary activity to covertly capture information on face washing behaviour of themself and any children aged 1-12. Children 4-12 years old directly participated in the survey and pictorial recall in a subset of households. The facial cleanliness of children aged 1-12 was assessed qualitatively and using the quantitative Personal Hygiene Assessment Tool (qPHAT). Prevalence estimates, sensitivity, specificity and predictive values were computed for each behavioural indicator with observation data as the gold standard. The appropriateness of script-based pictorial recall was assessed using baseline and 3-month follow-up data. Baseline data were collected from 204 households in 68 clusters. Survey estimates of face washing and face washing with soap among caregivers and children were 32% to 60% and 5% to 31% higher than observed behaviour, respectively. Face washing prevalence estimates from pictorial recall were lower than survey estimates and comparable with observations for some face washing with soap indicators (0.3% to 13% higher than observations). Specificity of pictorial recall indicators was high (85% to 99%), but the sensitivity was low (0% to 67%), resulting in a low positive predictive value for all indicators. Both qualitative facial cleanliness indicators and qPHAT scores were poorly correlated with observed face washing earlier that morning. Pictorial recall overestimated face washing with soap among both caregivers and children following intervention delivery but not at baseline. Survey (self)-reported data on face washing is highly inaccurate. Script-based pictorial recall does not correctly classify those who wash their face with soap, and is subject to differential bias following intervention exposure, and facial cleanliness is a poor indicator of recent face washing in settings where faces become rapidly dirty again after washing. Alternatives to structured observation cannot be recommended to monitor the effectiveness of face washing interventions in community settings. Trial Registration ISRCTN registry ISRCTN40760473, https://doi.org/10.1186/ISRCTN40760473.
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Affiliation(s)
- Katie Greenland
- Department for Disease Control, London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
| | - Claire Collin
- Department for Disease Control, London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
| | - Edao Sinba Etu
- Berhan Public Health & Eye Care Consultancy, Addis Ababa, Ethiopia
| | - Meseret Guye
- The Fred Hollows Foundation Ethiopia, Addis Ababa, Ethiopia
| | - Demitu Hika
- The Fred Hollows Foundation Ethiopia, Addis Ababa, Ethiopia
| | - David Macleod
- International Statistics and Epidemiology Group, LSHTM, London, United Kingdom
- International Centre for Eye Health, Clinical Research Department, LSHTM, London, United Kingdom
| | - Wolf-Peter Schmidt
- Department for Disease Control, London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
| | - Oumer Shafi Abdurahman
- The Fred Hollows Foundation Ethiopia, Addis Ababa, Ethiopia
- International Centre for Eye Health, Clinical Research Department, LSHTM, London, United Kingdom
| | - Anna Last
- International Centre for Eye Health, Clinical Research Department, LSHTM, London, United Kingdom
- Clinical Research Department, London School of Hygiene & Tropical Medicine (LSHTM)
| | - Matthew J. Burton
- International Centre for Eye Health, Clinical Research Department, LSHTM, London, United Kingdom
- National Institute for Health Research Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
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Shu’aibu J, Ajege G, Mpyet C, Dejene M, Isiyaku S, Tafida A, Kelly M, Emereuwa I, Courtright P. Optimizing Trichiasis Case Finding to Attain the Elimination of Trachoma as a Public Health Problem. Trop Med Infect Dis 2024; 9:157. [PMID: 39058199 PMCID: PMC11281651 DOI: 10.3390/tropicalmed9070157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 07/04/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND As national trachoma programmes increase efforts to reduce the burden of trachomatous trichiasis (TT), TT case finding and referral are critical public health programme components. Our research aimed to explore the most effective and efficient approaches to finding, referring, and managing TT cases. METHODS This was a prospective descriptive study, utilizing both routine programme data and primary data collection. This study compared four different approaches to finding TT cases across three different local government areas (LGAs) in Kano State, Nigeria. Each of the study LGAs was divided into four sub-units to accommodate the four different approaches. RESULTS The number of outreach attendees was 4795 across the four case finding approaches, and this varied hugely, with the smallest number and proportion (403, 0.26%) in settings only employing house-to-house case finding and the largest number and proportion (1901, 0.99%) when town criers were used. That said, the proportion of TT cases among people presenting at outreach was highest (32.5%) when house-to-house case finding was used and lowest (10.3%) when town criers were used. More female TT patients were found (53-70%) and had surgery (79-85%) compared to male cases, across all approaches. The average project expenditure for finding one TT case was similar for approaches that included house-to-house case finding (USD 5.4-6.3), while it was 3.5 times higher (USD 21.5 per TT case found) when town criers were used. DISCUSSION This study found that the house-to-house TT case finding approaches were the most efficient method with the highest yield of TT cases. Including other eye condition and/or vision testing yielded similar results but required more personnel and cost.
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Affiliation(s)
- Joy Shu’aibu
- Sightsavers, Abuja 900231, Nigeria
- Department of Family Medicine, Bingham University, Karu 961105, Nigeria
| | | | - Caleb Mpyet
- Sightsavers, Abuja 900231, Nigeria
- Department of Ophthalmology, University of Jos, Jos 930003, Nigeria
| | - Michael Dejene
- Public Health Consultancy Services, Addis Ababa 1169, Ethiopia
| | | | | | | | | | - Paul Courtright
- Kilimanjaro Centre for Community Ophthalmology, Division of Ophthalmology, University of Cape Town, Cape Town 7925, South Africa
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Hudu SA, Jimoh AO, Adeshina KA, Otalike EG, Tahir A, Hegazy AA. An insight into the Success, Challenges, and Future perspectives of eliminating Neglected tropical disease. SCIENTIFIC AFRICAN 2024; 24:e02165. [DOI: 10.1016/j.sciaf.2024.e02165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2024] Open
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Aquino-Canchari CR, Chavez-Bustamante SG. The 100 most cited articles on trachoma: a bibliometric analysis. Int Ophthalmol 2023; 43:4235-4246. [PMID: 37592115 DOI: 10.1007/s10792-023-02834-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 07/27/2023] [Indexed: 08/19/2023]
Abstract
OBJECTIVE Trachoma is the cause of blindness or visual impairment in 1.9 million people. Few bibliometric studies have been carried out, but none explore the characteristics of the 100 most cited articles on trachoma. METHODS A keyword-based search without time restriction was performed in September 2022 using the Scopus database. Search keywords include the following: "trachoma; trachome; tracoma; trachomatis." Two authors independently screened the literature and extracted data. The search result was obtained to classify the 100 articles according to their number of citations. RESULTS The Top 100 articles were published between 1957 and 2015 with a total of 11,102 citations (range 56-689). The country with the most significant contribution was the USA (n = 56). The Lancet was the most active journal (n = 15). Bailey RL was the author with the highest number of publications (n = 30). The Edna McConnell Clark Foundation (n = 26) was the most prominent funding entity. The type of original article was the most published (n = 83), in addition, the most frequent thematic area was prevention (n = 33). The most popular keywords were trachoma (n = 93), chlamydia trachomatis (n = 55), and azithromycin (n = 34). CONCLUSIONS The study provides new insight into trachoma research, information that may help healthcare providers, researchers, and stakeholders better understand trends and influential contributions. It highlights under-researched areas that could be the basis for future research.
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Affiliation(s)
- Christian Renzo Aquino-Canchari
- Facultad de Medicina Humana, Universidad Peruana los Andes, Sociedad Científica de Estudiantes de Medicina los Andes (SOCIEMLA), CC.HH Juan Parra del Riego, II Etapa, Block 2, Dpto:101, El Tambo, Huancayo, Peru.
| | - Sarai Gloria Chavez-Bustamante
- Facultad de Medicina Humana, Universidad Continental, Sociedad Científica Médico Estudiantil Continental (SOCIMEC), Huancayo, Peru
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Asmare ZA, Seifu BL, Mare KU, Asgedom YS, Kase BF, Shibeshi AH, Tebeje TM, Lombebo AA, Sabo KG, Fente BM, Teshale AB, Asebe HA. Prevalence and associated factors of active trachoma among 1-9 years of age children in Andabet district, northwest Ethiopia, 2023: A multi-level mixed-effect analysis. PLoS Negl Trop Dis 2023; 17:e0011573. [PMID: 37590321 PMCID: PMC10464999 DOI: 10.1371/journal.pntd.0011573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/29/2023] [Accepted: 08/05/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Trachoma is the chief cause of preventable blindness worldwide and has been earmarked for elimination as a public health problem by 2030. Despite the five-year Surgery, Antibiotics, Facial cleanliness, and Environmental improvement (SAFE)-based interventions in the Andabet district, the prevalence of trachomatous follicular (TF) was 37%. With such a high prevalence of TF, the determinant factors were not revealed. Besides, there were no reports on the overall prevalence of active trachoma (i.e.TF and or trachomatous intense (TI)). OBJECTIVE To determine the prevalence and associated factors of active trachoma among 1-9 years of age children in the Andabet district. METHOD A community-based cross-sectional study was conducted among children aged under nine years from March 1-30, 2023 in Andabet district, Northwest Ethiopia. Multi-stage systematic random sampling was employed to reach 540 children. A multilevel mixed-effect logistic regression analysis was employed to assess factors associated with active trachoma. We fitted both random effect and fixed effect analysis. Finally, variables with p<0.05 in the multivariable multilevel analysis were claimed to be significantly associated with active trachoma. RESULT In this study, the overall prevalence of active trachoma was 35.37% (95% CI: 31.32%, 39.41%). The prevalence of TF and TI was 31.3% and 4.07% respectively. In the multilevel logistic regression analysis ocular discharge, fly-eye contact, latrine utilization, and source of water were significantly associated with the prevalence of active trachoma. CONCLUSION In this study, the prevalence of active trachoma was much higher than the World Health Organization (WHO) threshold prevalence. Ocular discharge, fly-eye contact, latrine utilization, and source of water were independent determinants of active trachoma among children (1-9 years). Therefore, paying special attention to these high-risk groups could decrease the prevalence of a neglected hyperendemic disease, active trachoma.
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Affiliation(s)
- Zufan Alamrie Asmare
- Department of Ophthalmology, School of Medicine and Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Beminate Lemma Seifu
- Department of Public Health, Collage of Medicine and Health Science, Samara University, Afar, Ethiopia
| | - Kusse Urmale Mare
- Department of Nursing, College of Medicine and Health Sciences, Samara University, Afar, Ethiopia
| | - Yordanos Sisay Asgedom
- Department of Epidemiology and Biostatics, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Bizunesh Fantahun Kase
- Department of Public Health, Collage of Medicine and Health Science, Samara University, Afar, Ethiopia
| | - Abdu Hailu Shibeshi
- Department of Statistics, College of Natural and Computational Science, Samara University, Afar, Ethiopia
| | - Tsion Mulat Tebeje
- School of Public Health, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia
| | - Afework Alemu Lombebo
- School of Medicine, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Kebede Gemeda Sabo
- Department of Nursing, College of Medicine and Health Sciences, Samara University, Afar, Ethiopia
| | - Bezawit Melak Fente
- Department of General Midwifery, School of Midwifery, College of Medicine & Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Achamyeleh Birhanu Teshale
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Hiwot Altaye Asebe
- Department of Public Health, Collage of Medicine and Health Science, Samara University, Afar, Ethiopia
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Asmare ZA, Assefa NL, Abebe D, Nigatu SG, Alimaw YA. Trachoma prevention practice and associated factors among mothers having children aged under nine years in Andabet district, northwest Ethiopia, 2022: A multi-level analysis. PLoS Negl Trop Dis 2023; 17:e0011433. [PMID: 37390045 DOI: 10.1371/journal.pntd.0011433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 06/02/2023] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND The world health organization (WHO) adopted the Surgery, Antibiotic, facial cleanliness, and environmental improvement (SAFE) strategy for the prevention of trachoma, and different prevention strategies have been employed in Andabet district. Trachoma still has a high prevalence despite these efforts. So, it is imperative to assess ground trachoma prevention practice (TPP) since there are insufficient studies in the study area. OBJECTIVE To determine the magnitude and factors associated with TPP among mothers having children aged under nine years in Andabet district, Northwest Ethiopia. METHOD A community-based cross-sectional study involving 624 participants was conducted June 1-30, 2022. Systematic random sampling was carried out to select study participants. Multi-level binary logistic regression analysis was used to identify factors associated with poor TPP. Descriptive and summary statistics were performed and variables with p-value < 0.05 in the best-fitted model were declared to be significantly associated with poor TPP. RESULTS In this study, the proportion of poor TPP was found to be 50.16% (95%CI = 46.23, 54.08). In the multi-variable multi-level logistic regression; having no formal education (AOR = 2.95; 95%CI: 1.41,6.15) and primary education (AOR = 2.33; 95%CI:1.04, 5.24), being a farmer (AOR = 3.02; 95%CI:1.73,5.28), and merchant (AOR = 2.63; 95%CI:1.20, 5.75), time taken to water point >30 minutes (AOR = 4.60,95CI:1.30,16.26) and didn't receive health education about trachoma (AOR = 2.36;95CI:1.16,4.79) were significantly associated with poor TPP. CONCLUSION The proportion of poor TPP was high relative to other studies. Level of education, occupation, time taken to the water point, and health education were significantly associated with poor TPP. Therefore, taking special attention to these high-risk groups could decrease the poor TPP.
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Affiliation(s)
- Zufan Alamrie Asmare
- Department of Ophthalmology, School of Medicine and Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Natnael Lakachew Assefa
- Department of Optometry, School of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Dagmawi Abebe
- Department of Ophthalmology, School of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Solomon Gedlu Nigatu
- Department of Epidemiology & Biostatistics, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Yezinash Addis Alimaw
- Department of Optometry, School of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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Zoerhoff KL, Mbabazi PS, Gass K, Kraemer J, Fuller BB, Blair L, Bougma R, Meite A, Negussu N, Gashaw B, Nash SD, Biritwum NK, Lemoine JF, Ullyartha Pangaribuan H, Wijayanti E, Kollie K, Rasoamanamihaja CF, Juziwelo L, Mkwanda S, Rimal P, Gnandou I, Diop B, Dorkenoo AM, Bronzan R, Tukahebwa EM, Kabole F, Yevstigneyeva V, Bisanzio D, Courtney L, Koroma J, Endayishimye E, Reithinger R, Baker MC, Fleming FM. How well do coverage surveys and programmatically reported mass drug administration coverage match? Results from 214 mass drug administration campaigns in 15 countries, 2008-2017. BMJ Glob Health 2023; 8:e011193. [PMID: 37142297 PMCID: PMC10163531 DOI: 10.1136/bmjgh-2022-011193] [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: 11/11/2022] [Accepted: 03/18/2023] [Indexed: 05/06/2023] Open
Abstract
INTRODUCTION Delivering preventive chemotherapy through mass drug administration (MDA) is a central approach in controlling or eliminating several neglected tropical diseases (NTDs). Treatment coverage, a primary indicator of MDA performance, can be measured through routinely reported programmatic data or population-based coverage evaluation surveys. Reported coverage is often the easiest and least expensive way to estimate coverage; however, it is prone to inaccuracies due to errors in data compilation and imprecise denominators, and in some cases measures treatments offered as opposed to treatments swallowed. OBJECTIVE Analyses presented here aimed to understand (1) how often coverage calculated using routinely reported data and survey data would lead programme managers to make the same programmatic decisions; (2) the magnitude and direction of the difference between these two estimates, and (3) whether there is meaningful variation by region, age group or country. METHODS We analysed and compared reported and surveyed treatment coverage data from 214 MDAs implemented between 2008 and 2017 in 15 countries in Africa, Asia and the Caribbean. Routinely reported treatment coverage was compiled using data reported by national NTD programmes to donors, either directly or via NTD implementing partners, following the implementation of a district-level MDA campaign; coverage was calculated by dividing the number of individuals treated by a population value, which is typically based on national census projections and occasionally community registers. Surveyed treatment coverage came from post-MDA community-based coverage evaluation surveys, which were conducted as per standardised WHO recommended methodology. RESULTS Coverage estimates using routine reporting and surveys gave the same result in terms of whether the minimum coverage threshold was reached in 72% of the MDAs surveyed in the Africa region and in 52% in the Asia region. The reported coverage value was within ±10 percentage points of the surveyed coverage value in 58/124 of the surveyed MDAs in the Africa region and 19/77 in the Asia region. Concordance between routinely reported and surveyed coverage estimates was 64% for the total population and 72% for school-age children. The study data showed variation across countries in the number of surveys conducted as well as the frequency with which there was concordance between the two coverage estimates. CONCLUSIONS Programme managers must grapple with making decisions based on imperfect information, balancing needs for accuracy with cost and available capacity. The study shows that for many of the MDAs surveyed, based on the concordance with respect to reaching the minimum coverage thresholds, the routinely reported data were accurate enough to make programmatic decisions. Where coverage surveys do show a need to improve accuracy of routinely reported results, NTD programme managers should use various tools and approaches to strengthen data quality in order to use data for decision-making to achieve NTD control and elimination goals.
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Affiliation(s)
- Kathryn L Zoerhoff
- International Development Group, RTI International, Washington, District of Columbia, USA
- The Task Force for Global Health, Decatur, Georgia, USA
| | | | | | - John Kraemer
- School of Health, Georgetown University, Washington, District of Columbia, USA
| | - Brian B Fuller
- International Development Group, RTI International, Washington, District of Columbia, USA
- Helen Keller International, New York, New York, USA
| | | | - Roland Bougma
- Ministère de la Santé et de l'Hygiène Publique, Ouagadougou, Burkina Faso
| | - Aboulaye Meite
- Ministère de la Santé et de l'Hygiène Publique, Abidjan, Côte d'Ivoire
| | - Nebiyu Negussu
- Federal Ministry of Health, Addis Ababa, Addis Ababa, Ethiopia
| | | | | | | | | | | | | | | | | | | | | | - Pradip Rimal
- Ministry of Health and Population, Kathmandu, Nepal
| | - Issa Gnandou
- Ministère de la Santé Publique, de la Population, et des Affaires Sociales, Niamey, Niger
| | - Bocar Diop
- Ministère de la Santé et de l'Action Sociale, Dakar, Senegal
| | - Ameyo Monique Dorkenoo
- Ministère de la Santé, de l'Hygiène Publique, et de l'Accès Universel aux Soins, Lomé, Togo
| | | | | | - Fatima Kabole
- Zanzibar Ministry of Health, Stone Town, Tanzania, United Republic of
| | | | - Donal Bisanzio
- International Development Group, RTI International, Washington, District of Columbia, USA
| | - Lauren Courtney
- International Development Group, RTI International, Washington, District of Columbia, USA
| | | | | | - Richard Reithinger
- International Development Group, RTI International, Washington, District of Columbia, USA
| | - Margaret C Baker
- International Development Group, RTI International, Washington, District of Columbia, USA
- School of Health, Georgetown University, Washington, District of Columbia, USA
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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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Marques AP, Ramke J, Cairns J, Butt T, Zhang JH, Jones I, Jovic M, Nandakumar A, Faal H, Taylor H, Bastawrous A, Braithwaite T, Resnikoff S, Khaw PT, Bourne R, Gordon I, Frick K, Burton MJ. The economics of vision impairment and its leading causes: A systematic review. EClinicalMedicine 2022; 46:101354. [PMID: 35340626 PMCID: PMC8943414 DOI: 10.1016/j.eclinm.2022.101354] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/23/2022] [Accepted: 03/02/2022] [Indexed: 01/16/2023] Open
Abstract
Vision impairment (VI) can have wide ranging economic impact on individuals, households, and health systems. The aim of this systematic review was to describe and summarise the costs associated with VI and its major causes. We searched MEDLINE (16 November 2019), National Health Service Economic Evaluation Database, the Database of Abstracts of Reviews of Effects and the Health Technology Assessment database (12 December 2019) for partial or full economic evaluation studies, published between 1 January 2000 and the search dates, reporting cost data for participants with VI due to an unspecified cause or one of the seven leading causes globally: cataract, uncorrected refractive error, diabetic retinopathy, glaucoma, age-related macular degeneration, corneal opacity, trachoma. The search was repeated on 20 January 2022 to identify studies published since our initial search. Included studies were quality appraised using the British Medical Journal Checklist for economic submissions adapted for cost of illness studies. Results were synthesized in a structured narrative. Of the 138 included studies, 38 reported cost estimates for VI due to an unspecified cause and 100 reported costs for one of the leading causes. These 138 studies provided 155 regional cost estimates. Fourteen studies reported global data; 103/155 (66%) regional estimates were from high-income countries. Costs were most commonly reported using a societal (n = 48) or healthcare system perspective (n = 25). Most studies included only a limited number of cost components. Large variations in methodology and reporting across studies meant cost estimates varied considerably. The average quality assessment score was 78% (range 35-100%); the most common weaknesses were the lack of sensitivity analysis and insufficient disaggregation of costs. There was substantial variation across studies in average treatment costs per patient for most conditions, including refractive error correction (range $12-$201 ppp), cataract surgery (range $54-$3654 ppp), glaucoma (range $351-$1354 ppp) and AMD (range $2209-$7524 ppp). Future cost estimates of the economic burden of VI and its major causes will be improved by the development and adoption of a reference case for eye health. This could then be used in regular studies, particularly in countries with data gaps, including low- and middle-income countries in Asia, Eastern Europe, Oceania, Latin America and sub-Saharan Africa.
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Key Words
- AMD, Age- related macular degeneration
- DALYs, Disability Adjusted Life Years
- DR, Diabetic Retinopathy
- EU, European
- GBD, Global Burden of Disease
- Health economics
- ICD 11, International Statistical Classification of Diseases, Injuries and Causes of Death 11th revision
- LMICs, Low Middle Income Countries
- MSVI, Moderate and Severe Vision Impairment
- NR, Not reported
- Ophthalmology
- PPP, Purchasing power parity
- Public health
- QALYs, Quality Adjusted Life Years
- RE, Refractive Error
- Systematic review
- USD, United States Dollars ($)
- VI, Vision Impairment
- WHO, World Health Organization
- anti-VEGF, antivascular endothelial growth factor
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Affiliation(s)
- Ana Patricia Marques
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom
| | - Jacqueline Ramke
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
| | - John Cairns
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom
| | - Thomas Butt
- University College London, London, United Kingdom
| | - Justine H. Zhang
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom
- Royal Free Hospital, London, United Kingdom
| | - Iain Jones
- Sightsavers, Haywards Heath, United Kingdom
| | | | - Allyala Nandakumar
- Heller School for Social Policy and Management, Brandeis University, Waltham, MA, United States
| | - Hannah Faal
- Department of Ophthalmology, University of Calabar, Calabar, Nigeria
- Africa Vision Research Institute, Durban, Kwa-Zulu Natal, South Africa
| | - Hugh Taylor
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Andrew Bastawrous
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom
| | - Tasanee Braithwaite
- The Medical Eye Unit, Guy's and St Thomas' Hospital, London, United Kingdom
- School of Immunology and Microbiology and School of Life Course Sciences, Kings College, London, United Kingdom
| | - Serge Resnikoff
- Brien Holden Vision Institute and SOVS, University of New South Wales, Sydney, NSW, Australia
| | - Peng T. Khaw
- National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Rupert Bourne
- Vision and Eye Research Institute, School of Medicine, Anglia Ruskin University, Cambridge, United Kingdom
| | - Iris Gordon
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom
| | - Kevin Frick
- Johns Hopkins Carey Business School, Baltimore, MD, United States
| | - Matthew J. Burton
- National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
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10
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Zhang JH, Ramke J, Jan C, Bascaran C, Mwangi N, Furtado JM, Yasmin S, Ogundo C, Yoshizaki M, Marques AP, Buchan J, Holland P, Ah Tong BAM, Evans JR, Congdon N, Webson A, Burton MJ. Advancing the Sustainable Development Goals through improving eye health: a scoping review. Lancet Planet Health 2022; 6:e270-e280. [PMID: 35219448 DOI: 10.1016/s2542-5196(21)00351-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 11/30/2021] [Accepted: 12/09/2021] [Indexed: 06/14/2023]
Abstract
UN member states have committed to achieving the Sustainable Development Goals (SDGs) by 2030. This Review examines the published evidence on how improving eye health can contribute to advancing the SDGs (beyond SDG 3). We identified 29 studies that showed direct benefits from providing eye health services on SDGs related to one or more of poverty (SDGs 1, 2, and 8), education (SDG 4), equality (SDGs 5 and 10), and sustainable cities (SDG 11). The eye health services included cataract surgery, free cataract screening, provision of spectacles, trichiasis surgery, rehabilitation services, and rural community eye health volunteers. These findings provide a comprehensive perspective on the direct links between eye health services and advancing the SDGs. In addition, eye health services likely have indirect effects on multiple SDGs, mediated through one of the direct effects. Finally, there are additional plausible links to other SDGs, for which evidence has not yet been established.
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Affiliation(s)
- Justine H Zhang
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK; Manchester Royal Eye Hospital, Manchester, UK.
| | - Jacqueline Ramke
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK; School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
| | | | - Covadonga Bascaran
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Nyawira Mwangi
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK; Department of Clinical Medicine, Kenya Medical Training College, Nairobi, Kenya
| | - João M Furtado
- Division of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | | | - Cynthia Ogundo
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK; Department of Ophthalmology, Mbagathi Hospital, Nairobi, Kenya
| | - Miho Yoshizaki
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Ana Patricia Marques
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - John Buchan
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Peter Holland
- International Agency for the Prevention of Blindness, London, UK
| | | | - Jennifer R Evans
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK; Centre for Public Health, Queen's University, Belfast, UK
| | - Nathan Congdon
- Centre for Public Health, Queen's University, Belfast, UK; Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Aubrey Webson
- Permanent Mission of Antigua and Barbuda to the United Nations, New York, NY, USA
| | - Matthew J Burton
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK; National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
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11
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Marques AP, Ramke J, Cairns J, Butt T, Zhang JH, Muirhead D, Jones I, Tong BA, Swenor BK, Faal H, Bourne RR, Frick KD, Burton MJ. Global economic productivity losses from vision impairment and blindness. EClinicalMedicine 2021; 35:100852. [PMID: 33997744 PMCID: PMC8093883 DOI: 10.1016/j.eclinm.2021.100852] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 03/26/2021] [Accepted: 03/30/2021] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND In the absence of accessible, good quality eye health services and inclusive environments, vision loss can impact individuals, households and communities in many ways, including through increased poverty, reduced quality of life and reduced employment. We aimed to estimate the annual potential productivity losses associated with reduced employment due to blindness and moderate and severe vision impairment (MSVI) at a regional and global level. METHODS We constructed a model using the most recent economic, demographic (2018) and prevalence (2020) data. Calculations were limited to the working age population (15-64 years) and presented in 2018 US Dollars purchasing power parity (ppp). Two separate models, using Gross Domestic Product (GDP) and Gross National Income (GNI), were calculated to maximise comparability with previous estimates. FINDINGS We found that 160.7 million people with MSVI or blindness were within the working age and estimated that the overall relative reduction in employment by people with vision loss was 30.2%. Globally, using GDP we estimated that the annual cost of potential productivity losses of MSVI and blindness was $410.7 billion ppp (range $322.1 - $518.7 billion), or 0.3% of GDP. Using GNI, overall productivity losses were estimated at $408.5 billion ppp (range $320.4 - $515.9 billion), 0.5% lower than estimates using GDP. INTERPRETATION These findings support the view that blindness and MSVI are associated with a large economic impact worldwide. Reducing and preventing vision loss and developing and implementing strategies to help visually impaired people to find and keep employment may result in significant productivity gains. FUNDING MJB is supported by the Wellcome Trust (207472/Z/17/Z). JR's appointment at the University of Auckland is funded by the Buchanan Charitable Foundation, New Zealand. The Lancet Global Health Commission on Global Eye Health was supported by grants from The Queen Elizabeth Diamond Jubilee Trust, Moorfields Eye Charity (GR001061), NIHR Moorfields Biomedical Research Centre, The Wellcome Trust, Sightsavers, The Fred Hollows Foundation, The SEVA Foundation, The British Council for the Prevention of Blindness and Christian Blind Mission. The funders had no role in the design, conduct, data analysis of the study, or writing of the manuscript.
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Affiliation(s)
| | - Jacqueline Ramke
- London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
| | - John Cairns
- London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
| | - Thomas Butt
- University College London, London, United Kingdom
| | - Justine H. Zhang
- London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
- Manchester Royal Eye Hospital, Manchester, United Kingdom
| | - Debbie Muirhead
- The Fred Hollows Foundation, Melbourne, Australia
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Iain Jones
- Sightsavers, Haywards Heath, United Kingdom
| | | | - Bonnielin K Swenor
- The Wilmer Eye Institute, Johns Hopkins University, Baltimore, United States
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
| | - Hannah Faal
- Department of Ophthalmology, University of Calabar, Calabar, Nigeria
- Africa Vision Research Institute, Durban, Kwa-Zulu Natal, South Africa
| | - Rupert R.A. Bourne
- Vision & Eye Research Institute, Anglia Ruskin University, Cambridge, United Kingdom
- Department of Ophthalmology, Cambridge University Hospitals, Cambridge, United Kingdom
| | - Kevin D. Frick
- Carey Business School, Johns Hopkins University, Baltimore, United States
| | - Matthew J. Burton
- London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
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12
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Burton MJ, Ramke J, Marques AP, Bourne RRA, Congdon N, Jones I, Ah Tong BAM, Arunga S, Bachani D, Bascaran C, Bastawrous A, Blanchet K, Braithwaite T, Buchan JC, Cairns J, Cama A, Chagunda M, Chuluunkhuu C, Cooper A, Crofts-Lawrence J, Dean WH, Denniston AK, Ehrlich JR, Emerson PM, Evans JR, Frick KD, Friedman DS, Furtado JM, Gichangi MM, Gichuhi S, Gilbert SS, Gurung R, Habtamu E, Holland P, Jonas JB, Keane PA, Keay L, Khanna RC, Khaw PT, Kuper H, Kyari F, Lansingh VC, Mactaggart I, Mafwiri MM, Mathenge W, McCormick I, Morjaria P, Mowatt L, Muirhead D, Murthy GVS, Mwangi N, Patel DB, Peto T, Qureshi BM, Salomão SR, Sarah V, Shilio BR, Solomon AW, Swenor BK, Taylor HR, Wang N, Webson A, West SK, Wong TY, Wormald R, Yasmin S, Yusufu M, Silva JC, Resnikoff S, Ravilla T, Gilbert CE, Foster A, Faal HB. The Lancet Global Health Commission on Global Eye Health: vision beyond 2020. Lancet Glob Health 2021; 9:e489-e551. [PMID: 33607016 PMCID: PMC7966694 DOI: 10.1016/s2214-109x(20)30488-5] [Citation(s) in RCA: 500] [Impact Index Per Article: 166.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/21/2020] [Accepted: 11/02/2020] [Indexed: 01/19/2023]
Affiliation(s)
- Matthew J Burton
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; National Institute for Health Research Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.
| | - Jacqueline Ramke
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
| | - Ana Patricia Marques
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Rupert R A Bourne
- Vision and Eye Research Institute, Anglia Ruskin University, Cambridge, UK; Department of Ophthalmology, Cambridge University Hospitals, Cambridge, UK
| | - Nathan Congdon
- Centre for Public Health, Queen's University Belfast, Belfast, UK; Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | | | | | - Simon Arunga
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Department of Ophthalmology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Damodar Bachani
- John Snow India, New Delhi, India; Ministry of Health and Family Welfare, New Delhi, India
| | - Covadonga Bascaran
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Andrew Bastawrous
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Peek Vision, London, UK
| | - Karl Blanchet
- Geneva Centre of Humanitarian Studies, University of Geneva, Geneva, Switzerland
| | - Tasanee Braithwaite
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; The Medical Eye Unit, St Thomas' Hospital, London, UK
| | - John C Buchan
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - John Cairns
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Chimgee Chuluunkhuu
- Orbis International, Ulaanbaatar, Mongolia; Mongolian Ophthalmology Society, Ulaanbaatar, Mongolia
| | | | | | - William H Dean
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Division of Ophthalmology, University of Cape Town, Cape Town, South Africa
| | - Alastair K Denniston
- National Institute for Health Research Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK; Ophthalmology Department, University Hospital Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, UK; Health Data Research UK, London, UK
| | - Joshua R Ehrlich
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Paul M Emerson
- International Trachoma Initiative and Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jennifer R Evans
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Kevin D Frick
- Carey Business School, Johns Hopkins University, Baltimore, MD, USA
| | - David S Friedman
- Massachusetts Eye and Ear, Harvard Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - João M Furtado
- Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | | | - Stephen Gichuhi
- Department of Ophthalmology, University of Nairobi, Nairobi, Kenya
| | | | - Reeta Gurung
- Tilganga Institute of Ophthalmology, Kathmandu, Nepal
| | - Esmael Habtamu
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Eyu-Ethiopia Eye Health Research, Training, and Service Centre, Bahirdar, Ethiopia
| | - Peter Holland
- International Agency for the Prevention of Blindness, London, UK
| | - Jost B Jonas
- Institute of Clinical and Scientific Ophthalmology and Acupuncture Jonas and Panda, Heidelberg, Germany; Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland
| | - Pearse A Keane
- National Institute for Health Research Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Lisa Keay
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia; George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Rohit C Khanna
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia; Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, LV Prasad Eye Institute, Hyderabad, India; Brien Holden Eye Research Centre, LV Prasad Eye Institute, Hyderabad, India
| | - Peng Tee Khaw
- National Institute for Health Research Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - Fatima Kyari
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; College of Health Sciences, University of Abuja, Abuja, Nigeria
| | - Van C Lansingh
- Instituto Mexicano de Oftalmologia, Queretaro, Mexico; Centro Mexicano de Salud Visual Preventiva, Mexico City, Mexico; Help Me See, New York, NY, USA
| | - Islay Mactaggart
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - Milka M Mafwiri
- Department of Ophthalmology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Ian McCormick
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Priya Morjaria
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Lizette Mowatt
- University Hospital of the West Indies, Kingston, Jamaica
| | - Debbie Muirhead
- The Fred Hollows Foundation, Melbourne, Australia; Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Gudlavalleti V S Murthy
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Indian Institute of Public Health, Hyderabad, India
| | - Nyawira Mwangi
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Kenya Medical Training College, Nairobi, Kenya
| | - Daksha B Patel
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Tunde Peto
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | | | - Solange R Salomão
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Bernadetha R Shilio
- Department of Curative Services, Ministry of Health Community Development, Gender, Elderly, and Children, Dodoma, Tanzania
| | - Anthony W Solomon
- Department of Control of Neglected Tropical Diseases, WHO, Geneva, Switzerland
| | - Bonnielin K Swenor
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Hugh R Taylor
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Ningli Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China; Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Aubrey Webson
- Permanent Mission of Antigua and Barbuda to the United Nation, New York, NY, USA
| | - Sheila K West
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore; Duke-NUS Medical School, Singapore
| | - Richard Wormald
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; National Institute for Health Research Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | | | - Mayinuer Yusufu
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China; Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | | | - Serge Resnikoff
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia; Brien Holden Vision Institute, University of New South of Wales, Sydney, Australia
| | | | - Clare E Gilbert
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Allen Foster
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Hannah B Faal
- Department of Ophthalmology, University of Calabar, Calabar, Nigeria; Africa Vision Research Institute, Durban, South Africa
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Kirigia JM, Mburugu GN. The monetary value of human lives lost due to neglected tropical diseases in Africa. Infect Dis Poverty 2017; 6:165. [PMID: 29249201 PMCID: PMC5733961 DOI: 10.1186/s40249-017-0379-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 11/29/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Neglected tropical diseases (NTDs) are an important cause of death and disability in Africa. This study estimates the monetary value of human lives lost due to NTDs in the continent in 2015. METHODS The lost output or human capital approach was used to evaluate the years of life lost due to premature deaths from NTDs among 10 high/upper-middle-income (Group 1), 17 middle-income (Group 2) and 27 low-income (Group 3) countries in Africa. The future losses were discounted to their present values at a 3% discount rate. The model was re-analysed using 5% and 10% discount rates to assess the impact on the estimated total value of human lives lost. RESULTS The estimated value of 67 860 human lives lost in 2015 due to NTDs was Int$ 5 112 472 607. Out of that, 14.6% was borne by Group 1, 57.7% by Group 2 and 27.7% by Group 3 countries. The mean value of human life lost per NTD death was Int$ 231 278, Int$ 109 771 and Int$ 37 489 for Group 1, Group 2 and Group 3 countries, respectively. The estimated value of human lives lost in 2015 due to NTDs was equivalent to 0.1% of the cumulative gross domestic product of the 53 continental African countries. CONCLUSIONS Even though NTDs are not a major cause of death, they impact negatively on the productivity of those affected throughout their life-course. Thus, the case for investing in NTDs control should also be influenced by the value of NTD morbidity, availability of effective donated medicines, human rights arguments, and need to achieve the NTD-related target 3.3 of the United Nations Sustainable Development Goal 3 (on health) by 2030.
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Affiliation(s)
| | - Gitonga N Mburugu
- Meru University of Science and Technology, P.O. Box 972-60200, Meru, Kenya
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14
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Ferede AT, Dadi AF, Tariku A, Adane AA. Prevalence and determinants of active trachoma among preschool-aged children in Dembia District, Northwest Ethiopia. Infect Dis Poverty 2017; 6:128. [PMID: 28988539 PMCID: PMC5632823 DOI: 10.1186/s40249-017-0345-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 08/02/2017] [Indexed: 11/10/2022] Open
Abstract
Background Trachoma is an infectious eye disease caused by Chlamydia trachomatis, which is the leading infectious cause of blindness worldwide. In areas where trachoma is endemic, active trachoma is common among preschool-aged children, with varying magnitude. This study aimed to estimate the prevalence of active trachoma and associated risk factors among preschool-aged children in Dembia District, northwest Ethiopia. Methods A community-based cross-sectional survey was conducted among preschool-aged children of northwest Ethiopia. Multistage systematic random sampling was used to select 695 subjects. Trained clinical optometrists subjected each child to an ocular examination and assessed the presence of active trachoma. Face to face interview using pretested and structured questionnaire were conducted to collect data on possible risk factors. Trachoma cases were graded following a World Health Organization simplified grading scheme. All statistical analysis was carried out using the SPSS software version 20. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were used to identify factors associated with active trachoma. Results Of the 681 preschool-aged children studied, 18% (95% CI: 15.4% – 21.1%) had a prevalence of active trachoma. Children who had clean faces (absence of nasal and ocular discharges) had a lower chance of having active trachoma [aOR = 0.55, 95% CI: 0.37 – 0.82]. The odds of having active trachoma decreased with an increase in the distance to a water point [aOR = 0.51, 95% CI: 0.33 – 0.78]. Similarly, no or poor utilization of liquid waste disposal in the child’s household was associated with an increased chance of having active trachoma [aOR = 3.83, 95% CI: 1.26 – 11.61]. Conclusion The prevalence of active trachoma in these preschool-aged children was found to be high and needs special interventions that focus on educating families about proper face washing, liquid waste disposal, and improving safe water supply near the households. Electronic supplementary material The online version of this article (doi:10.1186/s40249-017-0345-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ayanaw Tsega Ferede
- Department of Optometry, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Abel Fekadu Dadi
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Amare Tariku
- Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Akilew Awoke Adane
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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15
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Crossland MD, Thomas R, Unwin H, Bharani S, Gothwal VK, Quartilho A, Bunce C, Dahlmann-Noor A. Tablet computers versus optical aids to support education and learning in children and young people with low vision: protocol for a pilot randomised controlled trial, CREATE (Children Reading with Electronic Assistance To Educate). BMJ Open 2017. [PMID: 28637740 PMCID: PMC5541522 DOI: 10.1136/bmjopen-2017-015939] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Low vision and blindness adversely affect education and independence of children and young people. New 'assistive' technologies such as tablet computers can display text in enlarged font, read text out to the user, allow speech input and conversion into typed text, offer document and spreadsheet processing and give access to wide sources of information such as the internet. Research on these devices in low vision has been limited to case series. METHODS AND ANALYSIS We will carry out a pilot randomised controlled trial (RCT) to assess the feasibility of a full RCT of assistive technologies for children/young people with low vision. We will recruit 40 students age 10-18 years in India and the UK, whom we will randomise 1:1 into two parallel groups. The active intervention will be Apple iPads; the control arm will be the local standard low-vision aid care. Primary outcomes will be acceptance/usage, accessibility of the device and trial feasibility measures (time to recruit children, lost to follow-up). Exploratory outcomes will be validated measures of vision-related quality of life for children/young people as well as validated measures of reading and educational outcomes. In addition, we will carry out semistructured interviews with the participants and their teachers. ETHICS AND DISSEMINATION NRES reference 15/NS/0068; dissemination is planned via healthcare and education sector conferences and publications, as well as via patient support organisations. TRIAL REGISTRATION NUMBER NCT02798848; IRAS ID 179658, UCL reference 15/0570.
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Affiliation(s)
| | - Rachel Thomas
- Optometry, Moorfields Eye Hospital at Bedford Hospital, Bedford, UK
| | - Hilary Unwin
- Sensory and Communication Support Team, The Child Development Centre, Kempston, Bedford, UK
| | - Seelam Bharani
- Meera and L B Deshpande Centre for Sight Enhancement, L V Prasad Eye Institute, Banjara Hills, Hyderabad, Telangana, India
| | - Vijaya K Gothwal
- Meera and L B Deshpande Centre for Sight Enhancement, L V Prasad Eye Institute, Banjara Hills, Hyderabad, Telangana, India
| | - Ana Quartilho
- NIHR Biomedical Research Centre, UCL Institute of Ophthalmology, London, UK
| | - Catey Bunce
- Department of Primary Care & Public Health Sciences, King’s College London, London, UK
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Phiri I, Manangazira P, Macleod CK, Mduluza T, Dhobbie T, Chaora SG, Chigwena C, Katiyo J, Willis R, Bakhtiari A, Bare P, Courtright P, Macheka B, Midzi N, Solomon AAW. The Burden of and Risk Factors for Trachoma in Selected Districts of Zimbabwe: Results of 16 Population-Based Prevalence Surveys. Ophthalmic Epidemiol 2017; 25:181-191. [PMID: 28532208 PMCID: PMC6319166 DOI: 10.1080/09286586.2017.1298823] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Background: Trachoma, a leading cause of blindness, is targeted for global elimination as a public health problem by 2020. In order to contribute to this goal, countries should demonstrate reduction of disease prevalence below specified thresholds, after implementation of the SAFE strategy in areas with defined endemicity. Zimbabwe had not yet generated data on trachoma endemicity and no specific interventions against trachoma have yet been implemented. Methods: Two trachoma mapping phases were successively implemented in Zimbabwe, with eight districts included in each phase, in September 2014 and October 2015. The methodology of the Global Trachoma Mapping Project was used. Results: Our teams examined 53,211 people for trachoma in 385 sampled clusters. Of 18,196 children aged 1–9 years examined, 1526 (8.4%) had trachomatous inflammation–follicular (TF). Trichiasis was observed in 299 (1.0%) of 29,519 people aged ≥15 years. Of the 16 districts surveyed, 11 (69%) had TF prevalences ≥10% in 1–9-year-olds, indicative of active trachoma being a significant public health problem, requiring implementation of the A, F and E components of the SAFE strategy for at least 3 years. The total estimated trichiasis backlog across the 16 districts was 5506 people. The highest estimated trichiasis burdens were in Binga district (1211 people) and Gokwe North (854 people). Conclusion: Implementation of the SAFE strategy is needed in parts of Zimbabwe. In addition, Zimbabwe needs to conduct more baseline trachoma mapping in districts adjacent to those identified here as having a public health problem from the disease.
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Affiliation(s)
- Isaac Phiri
- a Department of Epidemiology and Disease Control , Ministry of Health and Child Care , Harare , Zimbabwe
| | - Portia Manangazira
- a Department of Epidemiology and Disease Control , Ministry of Health and Child Care , Harare , Zimbabwe
| | - Colin K Macleod
- b Clinical Research Department , London School of Hygiene & Tropical Medicine , London , UK.,c Sightsavers, Haywards Heath , UK
| | - Takafira Mduluza
- d Department of Biochemistry , Faculty of Sciences, University of Zimbabwe , Mt Pleasant , Harare , Zimbabwe.,e School of Laboratory Medicine and Medical Sciences , College of Health Sciences, University of KwaZulu-Natal , Durban , South Africa
| | - Tinashe Dhobbie
- a Department of Epidemiology and Disease Control , Ministry of Health and Child Care , Harare , Zimbabwe
| | | | - Chriswell Chigwena
- a Department of Epidemiology and Disease Control , Ministry of Health and Child Care , Harare , Zimbabwe
| | - Joshua Katiyo
- a Department of Epidemiology and Disease Control , Ministry of Health and Child Care , Harare , Zimbabwe
| | | | | | | | - Paul Courtright
- i KCCO International, Division of Ophthalmology , University of Cape Town , South Africa
| | - Boniface Macheka
- j Department of Ophthalmology , Parirenyatwa Group of Hospitals , Harare , Zimbabwe
| | - Nicholas Midzi
- k Department of Medical Microbiology , College of Health Sciences, University of Zimbabwe , Harare , Zimbabwe
| | - And Anthony W Solomon
- b Clinical Research Department , London School of Hygiene & Tropical Medicine , London , UK.,l Department of Control of Neglected Tropical Diseases , World Health Organization , Geneva , Switzerland
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Ramyil A, Bascaran C, Bunce C, Alada J, Wade P, Mpyet C. Outcome of trachoma lid surgeries in Jigawa state, Nigeria. COGENT MEDICINE 2016. [DOI: 10.1080/2331205x.2016.1233683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Alice Ramyil
- Department of Ophthalmology, University of Jos and Jos University Teaching Hospital, Jos, Nigeria
| | - Covadonga Bascaran
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Catey Bunce
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
- University College London (UCL), London, UK
| | - Joel Alada
- Department of Ophthalmology, University of Jos and Jos University Teaching Hospital, Jos, Nigeria
| | - Patricia Wade
- Department of Ophthalmology, University of Jos and Jos University Teaching Hospital, Jos, Nigeria
| | - Caleb Mpyet
- Department of Ophthalmology, University of Jos and Jos University Teaching Hospital, Jos, Nigeria
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Ramyil A, Bascaran C, Bunce C, Wade P, Oyediji F, Mpyet C. An assessment of trichiasis surgery workforce in Jigawa State, Nigeria. COGENT MEDICINE 2016. [DOI: 10.1080/2331205x.2016.1259145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- A.V. Ramyil
- Depatment of Ophthalmology, Jos UniversityTeaching Hospital, Jos, Nigeria
| | - C. Bascaran
- Clinical Research Department, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Catey Bunce
- Department of Medical statistics, King's college London,, London, UK
| | - P. Wade
- Depatment of Ophthalmology, Jos UniversityTeaching Hospital, Jos, Nigeria
| | - F. Oyediji
- Depatment of Ophthalmology, Jos UniversityTeaching Hospital, Jos, Nigeria
| | - C. Mpyet
- Depatment of Ophthalmology, Jos UniversityTeaching Hospital, Jos, Nigeria
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Heggen AE, Solomon AW, Courtright P. Perspectives of National Coordinators and Partners on the Work of the Global Trachoma Mapping Project. Ophthalmic Epidemiol 2016; 23:366-372. [PMID: 27726463 PMCID: PMC6837863 DOI: 10.1080/09286586.2016.1229795] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Purpose Neglected tropical diseases (NTDs) affect people living in the poorest regions of the world and their debilitating effects perpetuate the poverty cycle. Understanding the distribution of NTDs is crucial for effective intervention delivery. In 2012, the Global Trachoma Mapping Project (GTMP) was initiated to map >1800 suspected trachoma endemic districts by March 2015. This research was carried out to better understand the implementation experience and identify lessons which might inform the GTMP and similar initiatives. Methods Using grounded theory methodology, semi-structured interviews were conducted with key informants from six countries with 63% of the global mapping backlog (Ethiopia, Malawi, Mozambique, Nigeria, Solomon Islands, and Yemen). Interviews were transcribed, coded, and findings separated into categories. Results Three themes were identified during the research; planning and operations, technical implementation, and governance. The project was felt to be most successful in countries where the Ministry of Health was actively engaged in setting standards, ensuring capacity building for government staff, and guiding the training, data collection, analysis, and interpretation of data. Standardized tools, training platforms, and the use of electronic data capture increased confidence in the reliability of the survey data, informed quality improvement efforts within survey implementation, and the immediate release of results empowered end-user decision-makers. Regional collaboration between endemic countries bolstered program manager competence and confidence, while reinforcing partnerships essential to the success of the GTMP. Conclusions We depict how innovative characteristics of the GTMP, and lessons learned from its implementation, can strengthen similar initiatives to map disease prevalence and risk factors.
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Affiliation(s)
- Anne E Heggen
- a Kilimanjaro Centre for Community Ophthalmology International , Division of Ophthalmology, Groote Schuur Hospital, Observatory , South Africa
| | - Anthony W Solomon
- b Clinical Research Department , London School of Hygiene & Tropical Medicine , London , UK
| | - Paul Courtright
- a Kilimanjaro Centre for Community Ophthalmology International , Division of Ophthalmology, Groote Schuur Hospital, Observatory , South Africa
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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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Muluneh EK, Zewotir T, Bekele Z. Rural children active trachoma risk factors and their interactions. Pan Afr Med J 2016; 24:128. [PMID: 27642466 PMCID: PMC5012742 DOI: 10.11604/pamj.2016.24.128.8790] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 03/07/2016] [Indexed: 11/11/2022] Open
Abstract
Introduction Trachoma is a serious public health problem in rural Ethiopia. The aim of this investigation was to provide in-depth statistical analysis of the risk factors associated with active trachoma among children of age 1-9 years of Kedida Gamela district, in Ethiopia. Methods A community based cross-sectional survey of trachoma was conducted in six selected rural kebeles of Kedida Gamela district, in Ethiopia from June 10-25, 2014. A total of 377 children (ages 1-9 years) were included in the study using two stage cluster sampling. All children were examined for trachoma by nurse data collectors supervised by ophthalmic supervisors using the WHO simplified clinical grading system. Ordinal survey logistic regression model was used to identify risk factors. Data analysis was done using SAS version 9.3. Results The best fit proportional odds model was identified to be the main effects and two-way and three-way interactios. Keeping cattle in the house was found to have a protective effect (OR=0.138, p-value=0.0003). The household wealth will have a more protective effect if the child attends school. Washing face with soap and water once a day has equivalent protective effect as washing face three-or-more times a day with water only. Conclusion The 2-way and 3-way significant interactions effects unfolded some of the controversies derived from similar studies on trachoma risk factors. The findings would suggest integrated effort to address two or three factors simultaneously is more fruitful than any novel intervention targeted to address a single risk factor.
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Affiliation(s)
| | - Temesgen Zewotir
- School of Mathematics, Statistics and Computer Science, University of Kwazulu Natal, South Africa
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Lenk EJ, Redekop WK, Luyendijk M, Rijnsburger AJ, Severens JL. Productivity Loss Related to Neglected Tropical Diseases Eligible for Preventive Chemotherapy: A Systematic Literature Review. PLoS Negl Trop Dis 2016; 10:e0004397. [PMID: 26890487 PMCID: PMC4758606 DOI: 10.1371/journal.pntd.0004397] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 12/29/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Neglected Tropical Diseases (NTDs) not only cause health and life expectancy loss, but can also lead to economic consequences including reduced ability to work. This article describes a systematic literature review of the effect on the economic productivity of individuals affected by one of the five worldwide most prevalent NTDs: lymphatic filariasis, onchocerciasis, schistosomiasis, soil-transmitted helminths (ascariasis, trichuriasis, and hookworm infection) and trachoma. These diseases are eligible to preventive chemotherapy (PCT). METHODOLOGY/PRINCIPAL FINDINGS Eleven bibliographic databases were searched using different names of all NTDs and various keywords relating to productivity. Additional references were identified through reference lists from relevant papers. Of the 5316 unique publications found in the database searches, thirteen papers were identified for lymphatic filariasis, ten for onchocerciasis, eleven for schistosomiasis, six for soil-transmitted helminths and three for trachoma. Besides the scarcity in publications reporting the degree of productivity loss, this review revealed large variation in the estimated productivity loss related to these NTDs. CONCLUSIONS It is clear that productivity is affected by NTDs, although the actual impact depends on the type and severity of the NTD as well as on the context where the disease occurs. The largest impact on productivity loss of individuals affected by one of these diseases seems to be due to blindness from onchocerciasis and severe schistosomiasis manifestations; productivity loss due to trachoma-related blindness has never been studied directly. However, productivity loss at an individual level might differ from productivity loss at a population level because of differences in the prevalence of NTDs. Variation in estimated productivity loss between and within diseases is caused by differences in research methods and setting. Publications should provide enough information to enable readers to assess the quality and relevance of the study for their purposes.
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Affiliation(s)
- Edeltraud J. Lenk
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - William K. Redekop
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Marianne Luyendijk
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | | | - Johan L. Severens
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Assessment of a Novel Approach to Identify Trichiasis Cases Using Community Treatment Assistants in Tanzania. PLoS Negl Trop Dis 2015; 9:e0004270. [PMID: 26658938 PMCID: PMC4676626 DOI: 10.1371/journal.pntd.0004270] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 11/08/2015] [Indexed: 11/29/2022] Open
Abstract
Background Simple surgical intervention advocated by the World Health Organization can alleviate trachomatous trichiasis (TT) and prevent subsequent blindness. A large backlog of TT cases remain unidentified and untreated. To increase identification and referral of TT cases, a novel approach using standard screening questions, a card, and simple training for Community Treatment Assistants (CTAs) to use during Mass Drug Administration (MDA) was developed and evaluated in Kongwa District, a trachoma-endemic area of central Tanzania. Methodology/Principal Findings A community randomized trial was conducted in 36 communities during MDA. CTAs in intervention villages received an additional half-day of training and a TT screening card in addition to the training received by CTAs in villages assigned to usual care. All MDA participants 15 years and older were screened for TT, and senior TT graders confirmed case status by evaluating all screened-positive cases. A random sample of those screened negative for TT and those who did not present at MDA were also evaluated by the master graders. Intervention CTAs identified 5.6 times as many cases (n = 50) as those assigned to usual care (n = 9, p < 0.05). While specificity was above 90% for both groups, the sensitivity for the novel screening tool was 31.2% compared to 5.6% for the usual care group (p < 0.05). Conclusions/Significance CTAs appear to be viable resources for the identification of TT cases. Additional training and use of a TT screening card significantly increased the ability of CTAs to recognize and refer TT cases during MDA; however, further efforts are needed to improve case detection and reduce the number of false positive cases. Surgical management of trachomatous trichiasis (TT) is recommended by the WHO as a cost-effective strategy to mitigate blinding trachoma. However, a large surgical backlog exists and many individuals suffering with TT remain unknown to the health system. To identify TT cases, we designed a standard set of screening questions, a card, and simple training for Community Treatment Assistants (CTAs) to identify trichiasis during community-wide Mass Drug Administrations (MDA). To evaluate the sensitivity, specificity, and positive predictive value of this approach, we conducted a community randomized trial in 36 communities in trachoma-endemic Kongwa District, Tanzania. Additional training and the use of a TT screening card increased the sensitivity of TT identification and resulted in more cases identified compared to the usual training of CTAs. The positive predictive value was low, indicating a need for further verification of TT cases identified by the enhanced screening. MDA appears to be a good opportunity for TT screening by CTAs, but further training to improve screening sensitivity is suggested.
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Habtamu E, Wondie T, Aweke S, Tadesse Z, Zerihun M, Zewdie Z, Callahan K, Emerson PM, Kuper H, Bailey RL, Mabey DCW, Rajak SN, Polack S, Weiss HA, Burton MJ. Trachoma and Relative Poverty: A Case-Control Study. PLoS Negl Trop Dis 2015; 9:e0004228. [PMID: 26600211 PMCID: PMC4657919 DOI: 10.1371/journal.pntd.0004228] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 10/22/2015] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Trachoma is widely considered a disease of poverty. Although there are many epidemiological studies linking trachoma to factors normally associated with poverty, formal quantitative data linking trachoma to household economic poverty within endemic communities is very limited. METHODOLOGY/PRINCIPAL FINDINGS Two hundred people with trachomatous trichiasis were recruited through community-based screening in Amhara Region, Ethiopia. These were individually matched by age and gender to 200 controls without trichiasis, selected randomly from the same sub-village as the case. Household economic poverty was measured through (a) A broad set of asset-based wealth indicators and relative household economic poverty determined by principal component analysis (PCA, (b) Self-rated wealth, and (c) Peer-rated wealth. Activity participation data were collected using a modified 'Stylised Activity List' developed for the World Bank's Living Standards Measurement Survey. Trichiasis cases were more likely to belong to poorer households by all measures: asset-based analysis (OR = 2.79; 95%CI: 2.06-3.78; p<0.0001), self-rated wealth (OR, 4.41, 95%CI, 2.75-7.07; p<0.0001) and peer-rated wealth (OR, 8.22, 95% CI, 4.59-14.72; p<0.0001). Cases had less access to latrines (57% v 76.5%, p = <0.0001) and higher person-to-room density (4.0 v 3.31; P = 0.0204) than the controls. Compared to controls, cases were significantly less likely to participate in economically productive activities regardless of visual impairment and other health problems, more likely to report difficulty in performing activities and more likely to receive assistance in performing productive activities. CONCLUSIONS/SIGNIFICANCE This study demonstrated a strong association between trachomatous trichiasis and relative poverty, suggesting a bidirectional causative relationship possibly may exist between poverty and trachoma. Implementation of the full SAFE strategy in the context of general improvements might lead to a virtuous cycle of improving health and wealth. Trachoma is a good proxy of inequality within communities and it could be used to target and evaluate interventions for health and poverty alleviation.
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Affiliation(s)
- Esmael Habtamu
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- The Carter Center, Addis Ababa, Ethiopia
| | | | | | | | | | | | - Kelly Callahan
- The Carter Center, Atlanta, Georgia, United States of America
| | - Paul M. Emerson
- International Trachoma Initiative, Atlanta, Georgia, United States of America
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Robin L. Bailey
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - David C. W. Mabey
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Saul N. Rajak
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sarah Polack
- International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Helen A. Weiss
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Matthew J. Burton
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Challenges and opportunities associated with neglected tropical disease and water, sanitation and hygiene intersectoral integration programs. BMC Public Health 2015; 15:547. [PMID: 26062691 PMCID: PMC4464235 DOI: 10.1186/s12889-015-1838-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 05/13/2015] [Indexed: 12/04/2022] Open
Abstract
Background Recent research has suggested that water, sanitation, and hygiene (WASH) interventions, in addition to mass drug administration (MDA), are necessary for controlling and eliminating many neglected tropical diseases (NTDs). Objectives This study investigated the integration of NTD and WASH programming in order to identify barriers to widespread integration and make recommendations about ideal conditions and best practices critical to future integrated programs. Methods Twenty-four in-depth, semi-structured interviews were conducted with key stakeholders in the global NTD and WASH sectors to identify barriers and ideal conditions in programmatic integration. Results The most frequently mentioned barriers to WASH and NTD integration included: 1) differing programmatic objectives in the two sectors, including different indicators and metrics; 2) a disproportionate focus on mass drug administration; 3) differences in the scale of funding; 4) siloed funding; and 5) a lack of coordination and information sharing between the two sectors. Participants also conveyed that a more holistic approach was needed if future integration efforts are to be scaled-up. The most commonly mentioned requisite conditions included: 1) education and advocacy; 2) development of joint indicators; 3) increased involvement at the ministerial level; 4) integrated strategy development; 5) creating task forces or committed partnerships; and 6) improved donor support. Conclusions Public health practitioners planning to integrate NTD and WASH programs can apply these results to create conditions for more effective programs and mitigate barriers to success. Donor agencies should consider funding more integration efforts to further test the proof of principle, and additional support from national and local governments is recommended if integration efforts are to succeed. Intersectoral efforts that include the development of shared indicators and objectives are needed to foster conditions conducive to expanding effective integration programs. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-1838-7) contains supplementary material, which is available to authorized users.
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Zambrano AI, Muñoz BE, Mkocha H, West SK. Exposure to an Indoor Cooking Fire and Risk of Trachoma in Children of Kongwa, Tanzania. PLoS Negl Trop Dis 2015; 9:e0003774. [PMID: 26046359 PMCID: PMC4457924 DOI: 10.1371/journal.pntd.0003774] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 04/21/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Elimination of blinding trachoma by 2020 can only be achieved if affected areas have effective control programs in place before the target date. Identifying risk factors for active disease that are amenable to intervention is important to successfully design such programs. Previous studies have linked sleeping by a cooking fire to trachoma in children, but not fully explored the mechanism and risks. We propose to determine the risk for active trachoma in children with exposure to cooking fires by severity of trachoma, adjusting for other known risk factors. METHODS Complete census of 52 communities in Kongwa, Tanzania, was conducted to collect basic household characteristics and demographic information on each family member. Information on exposure to indoor cooking fires while the mother was cooking and while sleeping for each child was collected. 6656 randomly selected children ages 1-9 yrs were invited to a survey where both eyelids were graded for follicular (TF) and intense trachoma (TI) using the WHO simplified grading scheme. Ocular swab were taken to assess the presence of Chlamydia trachomatis. FINDINGS 5240 (79%) of the invited children participated in the study. Overall prevalence for trachoma was 6·1%. Odds for trachoma and increased severity were higher in children sleeping without ventilation and a cooking fire in their room (TF OR = 1·81, 1·00-3·27 and TI OR 4·06, 1·96-8·42). Children with TF or TI who were exposed were more likely to have infection than children with TF or TI who were not exposed. There was no increased risk with exposure to a cooking fire while the mother was cooking. CONCLUSIONS In addition to known risk factors for trachoma, sleeping by an indoor cooking fire in a room without ventilation was associated with active trachoma and appears to substantially increase the risk of intense inflammation.
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Affiliation(s)
- Andrea I. Zambrano
- Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland, United States of America
- * E-mail:
| | - Beatriz E. Muñoz
- Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland, United States of America
| | | | - Sheila K. West
- Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland, United States of America
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Costs of testing for ocular Chlamydia trachomatis infection compared to mass drug administration for trachoma in the Gambia: application of results from the PRET study. PLoS Negl Trop Dis 2015; 9:e0003670. [PMID: 25901349 PMCID: PMC4406756 DOI: 10.1371/journal.pntd.0003670] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Accepted: 03/03/2015] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Mass drug administration (MDA) treatment of active trachoma with antibiotic is recommended to be initiated in any district where the prevalence of trachoma inflammation, follicular (TF) is ≥ 10% in children aged 1-9 years, and then to continue for at least three annual rounds before resurvey. In The Gambia the PRET study found that discontinuing MDA based on testing a sample of children for ocular Chlamydia trachomatis(Ct) infection after one MDA round had similar effects to continuing MDA for three rounds. Moreover, one round of MDA reduced disease below the 5% TF threshold. We compared the costs of examining a sample of children for TF, and of testing them for Ct, with those of MDA rounds. METHODS The implementation unit in PRET The Gambia was a census enumeration area (EA) of 600-800 people. Personnel, fuel, equipment, consumables, data entry and supervision costs were collected for census and treatment of a sample of EAs and for the examination, sampling and testing for Ct infection of 100 individuals within them. Programme costs and resource savings from testing and treatment strategies were inferred for the 102 EAs in the study area, and compared. RESULTS Census costs were $103.24 per EA plus initial costs of $108.79. MDA with donated azithromycin cost $227.23 per EA. The mean cost of examining and testing 100 children was $796.90 per EA, with Ct testing kits costing $4.80 per result. A strategy of testing each EA for infection is more expensive than two annual rounds of MDA unless the kit cost is less than $1.38 per result. However stopping or deciding not to initiate treatment in the study area based on testing a sample of EAs for Ct infection (or examining children in a sample of EAs) creates savings relative to further unnecessary treatments. CONCLUSION Resources may be saved by using tests for chlamydial infection or clinical examination to determine that initial or subsequent rounds of MDA for trachoma are unnecessary.
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Singer M, Bulled N. INTERLOCKED INFECTIONS: THE HEALTH BURDENS OF SYNDEMICS OF NEGLECTED TROPICAL DISEASES. ANNALS OF ANTHROPOLOGICAL PRACTICE 2013. [DOI: 10.1111/napa.12007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Strømme EM, Baerøe K, Norheim OF. Disease control priorities for neglected tropical diseases: lessons from priority ranking based on the quality of evidence, cost effectiveness, severity of disease, catastrophic health expenditures, and loss of productivity. Dev World Bioeth 2013; 14:132-41. [PMID: 23724925 DOI: 10.1111/dewb.12016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND In the context of limited health care budgets in countries where Neglected Tropical Diseases (NTDs) are endemic, scaling up disease control interventions entails the setting of priorities. However, solutions based solely on cost-effectiveness analyses may lead to biased and insufficiently justified priorities. OBJECTIVES The objectives of this paper are to 1) demonstrate how a range of equity concerns can be used to identify feasible priority setting criteria, 2) show how these criteria can be fed into a multi-criteria decision-making matrix, and 3) discuss the conditions under which this decision-making procedure should be carried out in a real-world decision-making context. METHODS This paper draws on elements from theories of decision analysis and ethical theories of fair resource allocation. We explore six typical NTD interventions by employing a modified multi-criteria decision analysis model with predefined criteria, drawn from a priority setting guide under development by the WHO. To identify relevant evidence for the six chosen interventions, we searched the PubMed and Cochrane databases. DISCUSSION Our in vitro multi-criteria decision analysis suggested that case management for visceral leishmaniasis should be given a higher priority than mass campaigns to prevent soil-transmitted helminthic infections. This seems to contradict current health care priorities and recommendations in the literature. We also consider procedural conditions that should be met in a contextualised decision-making process and we stress the limitations of this study exercise. CONCLUSION By exploring how several criteria relevant to the multi-facetted characteristics of NTDs can be taken into account simultaneously, we are able to suggest how improved priority settings among NTDs can be realised.
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Abstract
PURPOSE OF REVIEW To review recent clinical and epidemiological studies regarding the prevention, diagnosis, and treatment of trachoma. RECENT FINDINGS Newer studies propose novel diagnostic tests that appear sensitive for the detection of ocular chlamydial infection. For example, recent studies with ribosomal RNA-based nucleic acid amplification tests (NAATs) have demonstrated improved sensitivities compared to DNA-based NAATs; and the progression of scarring has now been characterized with confocal microscopy. Immunologic studies have further explored the etiology of clinical sequelae, suggesting that chronic inflammation can lead to progressive scarring even in the absence of Chlamydia. Mass oral azithromycin distributions remain a mainstay of treatment; studies have assessed the appropriate frequency and duration of treatment programs. Current studies have also explored ancillary effects of azithromycin distribution on mortality and bacterial infections. SUMMARY Trachoma programs have had remarkable success at reducing chlamydial infection and clinical signs of trachoma. Recent work suggests improved methods to monitor infection and scarring, and better ways to distribute treatment. Whereas studies continue to demonstrate reduction in infection in hyperendemic areas, more work is necessary to achieve elimination of this blinding disease.
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Abstract
Trachoma, a chronic conjunctivitis caused by Chlamydia trachomatis, is the leading infectious cause of blindness worldwide. In recognition of this public health problem, the World Health Assembly has targeted the year 2020 to eliminate blinding trachoma, and a multifaceted strategy (SAFE) is recommended, including antibiotics for treatment of infection. Trachoma is a disease of entire communities, and the pool of infection resides largely in preschool age children. Thus, for endemic communities, mass treatment with antibiotics annually for at least 3-5 years is carried out. The antibiotics used, the effectiveness of this approach, and the challenges of antibiotic treatment of communities are discussed, concluding with a view towards the elimination of trachoma in the future.
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Affiliation(s)
- Sheila West
- Wilmer RM 129, Johns Hopkins University, 600 N Wolfe Street, Baltimore, MD 21205, USA.
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The burden of trachoma in South Sudan: assessing the health losses from a condition of graded severity. PLoS Negl Trop Dis 2012; 6:e1538. [PMID: 22413025 PMCID: PMC3295813 DOI: 10.1371/journal.pntd.0001538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Accepted: 12/24/2011] [Indexed: 11/19/2022] Open
Abstract
Introduction Trachoma is a disease that can lead to visual impairment and ultimately blindness. Previous estimates of health losses from trachoma using the Global Burden of Disease methodology have not, however, included the stage prior to visual impairment. We estimated the burden of all stages of trachoma in South Sudan and assessed the uncertainty associated with the severity and duration of stages of trachoma prior to full blindness. Methods The prevalence of trachoma with normal vision, low vision and blindness in the Republic of South Sudan has been estimated previously. These estimates were used to model the incidence and duration of the different stages employing DISMOD II. Different assumptions about disability weights and duration were used to estimate the Years Lived with Disability (YLD). Results We have estimated the total burden of trachoma in South Sudan to be between 136,562 and 163,695 YLD and trichiasis with normal vision contributes between 5% and 21% of the total depending on the disability weight applied. Women experience more of this burden than men. The sensitivity of the results to different assumptions about the disability weights is partly dependent upon the assumed duration of the different disease states. Interpretation A better understanding of the natural history of trachoma is critical for a more accurate burden estimate. Trachoma is an infectious disease that is endemic to the Republic of South Sudan. In the absence of appropriate treatment recurrent re-infection in an individual will lead to progressively severe states of trachoma, eventually leading to the loss of visual acuity and finally blindness. Here we distinguish between three separate states of disease: trachoma with normal vision, trachoma with low vision and trachoma with blindness. The first of these states, trachoma with normal vision, is the least severe and the impact of this state on a population has not been well investigated. Trachoma, even before any loss of vision, comes with a great deal of pain and social consequences, and thus disability. In this study we employ data from South Sudan and estimate the burden caused by trachoma with normal vision for the first time. In doing so, we also reveal the extent of the gaps in our knowledge surrounding the natural history of trachoma and highlight areas of research that require urgent attention.
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Trachomatous trichiasis and its management in endemic countries. Surv Ophthalmol 2012; 57:105-35. [PMID: 22285842 PMCID: PMC3316859 DOI: 10.1016/j.survophthal.2011.08.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Revised: 08/09/2011] [Accepted: 08/11/2011] [Indexed: 11/20/2022]
Abstract
Trichiasis is the sight-threatening consequence of conjunctival scarring in trachoma, the most common infectious cause of blindness worldwide. Trachomatous trichiasis is the result of multiple infections from childhood with Chlamydia trachomatis, which causes recurrent chronic inflammation in the tarsal conjunctiva. This produces conjunctival scarring, entropion, trichiasis, and ultimately blinding corneal opacification. The disease causes painful, usually irreversible sight loss. Over eight million people have trachomatous trichiasis, mostly those living in poor rural communities in 57 endemic countries. The global cost is estimated at US$ 5.3 billion. The WHO recommends surgery as part of the SAFE strategy for controlling the disease.We examine the principles of clinical management, treatment options, and the challenging issues of providing the quantity and quality of surgery that is needed in resource-poor settings.
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Koroma JB, Heck E, Vandy M, Sonnie M, Hodges M, MacArthur C, Sankara DP. The epidemiology of trachoma in the five northern districts of Sierra Leone. Ophthalmic Epidemiol 2011; 18:150-7. [PMID: 21780873 DOI: 10.3109/09286586.2011.594204] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE In 2008, a trachoma prevalence survey was conducted in the five northern districts of Sierra Leone to determine if and where specific components of the SAFE strategy (Surgery, Antibiotics, Face washing, Environmental change) should be initiated. METHODS A cross-sectional survey at district level was implemented using two-stage random cluster sampling: probability proportionate sampling was used to select villages in the first stage and compact segment sampling of households in the second stage. Both eyes of 16,780 individuals were examined using the World Health Organization simplified trachoma grading system. Data were also collected on village- and household-level behavior and environmental factors related to trachoma. RESULTS Prevalence of trachomatous inflammation-follicular (TF) in children aged 1-9 years was highest in Kambia at 3.52% (95% Confidence Interval (CI): 2.28-4.75%), while the prevalence of trachomatous trichiasis (TT) in persons over 15 years of age was highest in Port Loko at 0.27% (95% CI: 0.03-0.50%). Across all districts, the percentage of households reporting washing children's faces less than once per day was very low, while latrine coverage and accessible and safe water sources were not highly prevalent. CONCLUSIONS In all districts but Koinadugu, TT prevalence was greater than the WHO elimination threshold, indicating the need for 1,016 TT surgeries to prevent blindness. District TF prevalence rates did not warrant mass antibiotic distribution. Although not required given the low prevalence of TF, we recommend the construction of 35,941 household latrines and provision of water sources within a 30-minute walk roundtrip for 17,551 households to bring Sierra Leone closer to reaching Millennium Development Goal 7.
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Affiliation(s)
- Joseph Brima Koroma
- Neglected Tropical Diseases Control Programme, Ministry of Health and Sanitation, Government of Sierra Leone, New England, Freetown, Sierra Leone
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Rabiu MM, Muhammed N, Isiyaku S. Challenges of trachoma control: an assessment of the situation in northern Nigeria. Middle East Afr J Ophthalmol 2011; 18:115-22. [PMID: 21731321 PMCID: PMC3119279 DOI: 10.4103/0974-9233.80699] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Over the last three decades, a lot has been achieved in the control of trachoma worldwide. New assessment techniques, effective evidence-based control strategy with new methods and drugs, and an aggressive global partnership for the control of the disease have evolved. As such the number of people with the disease and blindness due to the disease had drastically reduced. Trachoma is now only responsible for about 4% of blindness worldwide down from 12% some few decades ago. Some countries are on the verge of eliminating the disease as a public health problem. Despite these achievements numerous challenges remain for achieving trachoma control in endemic communities. This article highlights the challenges faced in one of the known trachoma endemic areas – northern Nigeria. Aspects on the dearth of complete situational data on trachoma, fragmented implementation of the SAFE strategy, community apathy, difficulties faced in ensuring safe, and quality lid surgery in the most difficult terrain where the disease thrives are discussed here. Other unique challenges like managing children with severe trichiasis, curbing the high rate of early-onset recurrence of trichiasis after lid rotation surgery and challenges to maintain supply of antibiotics and implementation of facial cleanliness and environmental improvement components of the control strategy are presented along with the learnt experiences and recommendations. These challenges and their remedies are likely to be shared by other trachoma endemic areas in Africa.
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Affiliation(s)
- Mansur M Rabiu
- Director of Programmes, Prevention of Blindness Union, Riyadh, Saudi Arabia
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Hu VH, Harding-Esch EM, Burton MJ, Bailey RL, Kadimpeul J, Mabey DCW. Epidemiology and control of trachoma: systematic review. Trop Med Int Health 2010; 15:673-91. [PMID: 20374566 PMCID: PMC3770928 DOI: 10.1111/j.1365-3156.2010.02521.x] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Trachoma is the commonest infectious cause of blindness. Recurrent episodes of infection with serovars A-C of Chlamydia trachomatis cause conjunctival inflammation in children who go on to develop scarring and blindness as adults. It was estimated that in 2002 at least 1.3 million people were blind from trachoma, and currently 40 million people are thought to have active disease and 8.2 million to have trichiasis. The disease is largely found in poor, rural communities in developing countries, particularly in sub-Saharan Africa. The WHO promotes trachoma control through a multifaceted approach involving surgery, mass antibiotic distribution, encouraging facial cleanliness and environmental improvements. This has been associated with significant reductions in the prevalence of active disease over the past 20 years, but there remain a large number of people with trichiasis who are at risk of blindness.
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Affiliation(s)
- Victor H Hu
- London School of Hygiene and Tropical Medicine, UK.
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Chu BK, Hooper PJ, Bradley MH, McFarland DA, Ottesen EA. The economic benefits resulting from the first 8 years of the Global Programme to Eliminate Lymphatic Filariasis (2000-2007). PLoS Negl Trop Dis 2010; 4:e708. [PMID: 20532228 PMCID: PMC2879371 DOI: 10.1371/journal.pntd.0000708] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2009] [Accepted: 04/20/2010] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Between 2000-2007, the Global Programme to Eliminate Lymphatic Filariasis (GPELF) delivered more than 1.9 billion treatments to nearly 600 million individuals via annual mass drug administration (MDA) of anti-filarial drugs (albendazole, ivermectin, diethylcarbamazine) to all at-risk for 4-6 years. Quantifying the resulting economic benefits of this significant achievement is important not only to justify the resources invested in the GPELF but also to more fully understand the Programme's overall impact on some of the poorest endemic populations. METHODOLOGY To calculate the economic benefits, the number of clinical manifestations averted was first quantified and the savings associated with this disease prevention then analyzed in the context of direct treatment costs, indirect costs of lost-labor, and costs to the health system to care for affected individuals. Multiple data sources were reviewed, including published literature and databases from the World Health Organization, International Monetary Fund, and International Labour Organization PRINCIPAL FINDINGS An estimated US$21.8 billion of direct economic benefits will be gained over the lifetime of 31.4 million individuals treated during the first 8 years of the GPELF. Of this total, over US$2.3 billion is realized by the protection of nearly 3 million newborns and other individuals from acquiring lymphatic filariasis as a result of their being born into areas freed of LF transmission. Similarly, more than 28 million individuals already infected with LF benefit from GPELF's halting the progression of their disease, which results in an associated lifetime economic benefit of approximately US$19.5 billion. In addition to these economic benefits to at-risk individuals, decreased patient services associated with reduced LF morbidity saves the health systems of endemic countries approximately US$2.2 billion. CONCLUSIONS/SIGNIFICANCE MDA for LF offers significant economic benefits. Moreover, with favorable program implementation costs (largely a result of the sustained commitments of donated drugs from the pharmaceutical industry) it is clear that the economic rate of return of the GPELF is extremely high and that this Programme continues to prove itself an excellent investment in global health.
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Affiliation(s)
- Brian K Chu
- Lymphatic Filariasis Support Center, The Task Force for Global Health, Decatur, Georgia, USA.
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Abstract
Although many examples of highly cost-effective interventions to control neglected tropical diseases exist, our understanding of the full economic effect that these diseases have on individuals, households, and nations needs to be improved to target interventions more effectively and equitably. We review data for the effect of neglected tropical diseases on a population's health and economy. We also present evidence on the costs, cost-effectiveness, and financing of strategies to monitor, control, or reduce morbidity and mortality associated with these diseases. We explore the potential for economies of scale and scope in terms of the costs and benefits of successfully delivering large-scale and integrated interventions. The low cost of neglected tropical disease control is driven by four factors: the commitment of pharmaceutical companies to provide free drugs; the scale of programmes; the opportunities for synergising delivery modes; and the often non-remunerated volunteer contribution of communities and teachers in drug distribution. Finally, we make suggestions for future economic research.
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Affiliation(s)
- Lesong Conteh
- London School of Hygiene and Tropical Medicine, London, UK.
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Liese B, Rosenberg M, Schratz A. Programmes, partnerships, and governance for elimination and control of neglected tropical diseases. Lancet 2010; 375:67-76. [PMID: 20109865 DOI: 10.1016/s0140-6736(09)61749-9] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Neglected tropical diseases represent one of the most serious burdens to public health. Many can be treated cost-effectively, yet they have been largely ignored on the global health policy agenda until recently. In this first paper in the Series we review the fragmented structure of elimination and control programmes for these diseases, starting with the ambiguous definition of a neglected tropical disease. We describe selected international control initiatives and present their effect, governance arrangements, and financing mechanisms, including substantial drug-donation programmes. We also discuss efforts to exploit shared features of these diseases by integration of selected control activities within countries, thus creating economies of scope. Finally we address the challenges, resulting from the diversity of disease control approaches and governance structures-both nationally and internationally-and provide some suggestions for the way forward.
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Affiliation(s)
- Bernhard Liese
- Department of International Health, Georgetown University, Washington, DC 20007, USA.
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Abstract
Trachoma is the commonest infectious cause of blindness worldwide. Recurrent infection of the ocular surface by Chlamydia trachomatis, the causative agent, leads to inturning of the eyelashes (trichiasis) and blinding corneal opacification. Trachoma is endemic in more than 50 countries. It is currently estimated that there are about 1.3 million people blind from the disease and a further 8.2 million have trichiasis. Several estimates for the burden of disease from trachoma have been made, giving quite variable results. The variation is partly because different prevalence data have been used and partly because different sequelae have been included. The most recent estimate from the WHO placed it at around 1.3 million Disability-Adjusted Life Years (DALYs). A key issue in producing a reliable estimate of the global burden of trachoma is the limited amount of reliable survey data from endemic regions.
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Affiliation(s)
- Matthew J Burton
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.
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Hotez PJ, Fenwick A, Savioli L, Molyneux DH. Rescuing the bottom billion through control of neglected tropical diseases. Lancet 2009; 373:1570-5. [PMID: 19410718 DOI: 10.1016/s0140-6736(09)60233-6] [Citation(s) in RCA: 537] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Peter J Hotez
- Sabin Vaccine Institute and George Washington University, Washington, DC 20037, USA.
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Abbas M, Bobo LD, Hsieh YH, Berka N, Dunston G, Bonney GE, Apprey V, Quinn TC, West SK. Human leukocyte antigen (HLA)-B, DRB1, and DQB1 allotypes associated with disease and protection of trachoma endemic villagers. Invest Ophthalmol Vis Sci 2008; 50:1734-8. [PMID: 18824733 DOI: 10.1167/iovs.08-2053] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Trachoma remains the leading preventable infectious cause of blindness in developing countries. Human leukocyte antigen (HLA) associations with ocular disease severity and persistent Chlamydia trachomatis infection of Tanzanians living in trachoma-endemic villages were examined to determine possible protective candidate allotypes for vaccine development. METHODS Buccal swab scrapes were taken from subjects in the Trichiasis Study Group (TSG), which studied females only, and the Family Trachoma Study (FTS), which compared persistently infected probands who had severe disease with disease-free siblings and parents. DNA was purified for polymerase chain reaction sequence-specific oligonucleotide identification of HLA-DRB1, DQB1, and B allotypes. Infection was detected from conjunctival scrapes using a C. trachomatis-specific PCR-enzyme immunoassay for the MOMP-1 gene. RESULTS In the TSG, DR*B11 (odds ratio [OR], 0.48; 95% confidence interval [CI], 0.26-0.90; P=0.02) was significantly associated with lack of trichiasis, whereas HLA-B*07 (OR, 3.26; 95% CI, 1.42-7.49; P=0.004) and HLA-B*08 (OR, 5.12; 95% CI, 1.74-15.05; P=0.001) were associated with trichiasis. In addition, HLA-B*14 was significantly associated with inflammatory trachoma + follicular trachoma (OR, 3.76; 95% CI, 1.70-8.33; P=0.04). There were no significant allele frequencies for the FTS. CONCLUSIONS The data suggest that HLA-DRB*11 may offer protection from trichiasis in trachoma hyperendemic villages. Complete allotype identification and designation of its respective protective CD4(+) T-cell antigens could provide a testable candidate vaccine for blindness prevention. Additionally, buccal swab DNA was sufficiently stable when acquired under harsh field conditions and stored long term in the freezer for low-resolution HLA typing.
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Affiliation(s)
- Muneer Abbas
- National Human Genome Center, Howard University, Washington, DC, USA
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Abstract
Africa carries a disproportionate responsibility in terms of blindness and visual impairment. With approximately 10 per cent of the world's population, Africa has 19 per cent of the world's blindness. It is no surprise that this reality also mirrors the situation in terms of the burden of world poverty. There is an increasing recognition of the need to highlight the link between poverty, development and health care. Blindness, disabling visual impairment and the overall lack of eye-care services are too often the result of social, economic and developmental challenges of the developing world. The state of eye care in Africa stands in alarming contrast to that in the rest of the world. Poor practitioner-to-patient ratios, absence of eye-care personnel, inadequate facilities, poor state funding and a lack of educational programs are the hallmarks of eye care in Africa, with preventable and treatable conditions being the leading cause of blindness. Eye diseases causing preventable blindness are often the result of a combination of factors such as poverty, lack of education and inadequate health-care services. The challenge that Vision 2020 has set itself in Africa is enormous. Africa is not a homogenous entity, the inter- and intra-country differences in economic development, prevalence of disease, delivery infrastructure and human resources amplify the challenges of meeting eye-care needs. The successful implementation of Vision 2020 programs will be hindered without the development of a comprehensive, co-ordinated strategy that is cognisant of the differences that exist and the need for comprehensive solutions that are rooted in the economic and political realities of the continent as well as the individual countries and regions within countries. This strategy should recognise the need for economic growth that results in greater state funded eye-care services that focus on health promotion to ensure the prevention of eye disease, the development of eye clinics in hospitals and health clinics, and the training of the appropriate human resources.
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Affiliation(s)
- Kovin Naidoo
- International Center for Eye Care Education (ICEE), African Vision Research Institute, University of KwaZulu-Natal, South Africa.
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Hotez PJ, Molyneux DH, Fenwick A, Kumaresan J, Sachs SE, Sachs JD, Savioli L. Control of neglected tropical diseases. N Engl J Med 2007; 357:1018-27. [PMID: 17804846 DOI: 10.1056/nejmra064142] [Citation(s) in RCA: 967] [Impact Index Per Article: 56.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Peter J Hotez
- Sabin Vaccine Institute, and the Department of Microbiology, Immunology, and Tropical Medicine, George Washington University, Washington, DC 20037, USA.
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Abstract
These diseases could be controlled or eliminated in our lifetimes if efforts are better coordinated
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Hotez P, Ottesen E, Fenwick A, Molyneux D. The Neglected Tropical Diseases: The Ancient Afflictions of Stigma and Poverty and the Prospects for their Control and Elimination. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2006; 582:23-33. [PMID: 16802616 DOI: 10.1007/0-387-33026-7_3] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Peter Hotez
- Department of Microbiology, Immunology and Tropical Medicine, The George Washington University and Sabin Vaccine Institute, Washington, DC 20037, USA
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Singer MS, Dana R. Recent advances in the global effort to eradicate trachoma. Int Ophthalmol Clin 2006; 46:79-90. [PMID: 16770156 DOI: 10.1097/00004397-200604620-00009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Affiliation(s)
- Michael S Singer
- Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA
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Molyneux DH, Hotez PJ, Fenwick A. "Rapid-impact interventions": how a policy of integrated control for Africa's neglected tropical diseases could benefit the poor. PLoS Med 2005; 2:e336. [PMID: 16212468 PMCID: PMC1253619 DOI: 10.1371/journal.pmed.0020336] [Citation(s) in RCA: 342] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Controlling seven tropical infections in Africa would cost just 40 cents per person per year, and would permanently benefit hundreds of millions of people.
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Affiliation(s)
| | - Peter J Hotez
- *To whom correspondence should be addressed. E-mail:
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50
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Abstract
Trachoma accounts for 15% of blindness worldwide, affecting the world's poorest communities. How can the disease be controlled?
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