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

Background

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

Objectives

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

Methods

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

Result

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

Conclusion

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

Status of active trachoma infection among school children who live in villages of open field defecation: a comparative cross-sectional study

BACKGROUND

Although many efforts are made by different stakeholders, magnitude of active trachoma remains high among children in Ethiopia. Open field defecation was found to be the main source of active trachoma. However, comparative information on the effect of open field defecation and non-open field defecation on active trachoma is scarce in Ethiopia.

METHODS

Comparative community based cross-sectional study was conducted from June 1-30, 2019 in Boricha and Dale districts to assess prevalence of active trachoma among primary school children. We have selected four primary schools purposively from two districts in Sidama. Study participants were selected by using simpe random sampling method. Data were collected through face to face interview, direct observation and ophthalmic examination. Logistic regression analysis was conducted to assess factors associated with active trachoma infection among primary school children. Adjusted Odds Ratios with 95% confidence interval and p-value less than 0.05 were computed to determine the level of significance.

RESULT

From the total of 746 study participants, only 701 study participants gave full response for interview questions making a response rate of 94%. The overall prevalence of active trachoma infection was 17.5% (95% CI, 14.1-20.8) among primary school students. Specifically, prevalence of active trachoma infection was 67.5% among children who lived in open field defecation villages, but it was 88.5% among school children who live in Non-ODF Kebeles. Factors like: Living in open field defecation Kebeles (AOR = 2.52, 95% CI, 1.5-4.1), having ocular discharge (AOR = 5.715, 95% CI, 3.4-9.4), having nasal discharge (AOR = 1.9, 95% CI, 1.06-3.39), and fly on the face (AOR = 6.47, 95% CI, 3.36-12.44) of children were positively associated with active trachoma infection. However, finger cleanness (AOR = 0.43, 95% CI, 0.21-0.9) was protective factor against active trachoma infection in this study.

CONCLUSION

Significant variation in prevalence of active trachoma infection among school children between open filed and non-open field defecation Kebeles was observed. Surprisingly, the prevalence in open field defecation was significantly lower than non-open field defecation. Hence, this indicates active trachoma infection highly depends on the hand hygiene than environmental sanitation. Educational campaign of hand hygiene should be enhanced in the community for school students.

Low prevalence of active trachoma and associated factors among children aged 1-9 years in rural communities of Metema District, Northwest Ethiopia: a community based cross-sectional study

BACKGROUND

Trachoma is an infectious disease of the eye caused by Chlamydia trachomatis and transmitted via contact with eye discharge from infected persons and leading to blindness worldwide. Children less than 9 years of age affected more seriously. The disease is common where access to water and sanitation are limited.

OBJECTIVE

To determine the prevalence of active trachoma and associated factors among children aged 1-9 years in rural communities of Metema District, West Gondar Zone, Northwest Ethiopia.

METHOD

A community based cross-sectional study design was used to collect data from 792 children aged 1-9 years old in Metema district from April to May 2018. Multistage sampling technique was used to select the study participants. Pretested interviewer-administered structured questionnaire and eye examination using binocular loupe to differentiate trachoma cases was the data collection methods and tools. The bivariable and multivariable binary logistic regression model was employed for analysis. P-value < 0.05 was considered to declare statistical significance.

RESULTS

A total of 752 children aged l-9 years were enrolled in this study with response rate of 94.9%. The overall prevalence of active trachoma among the study participants was 11.8% (95% CI, 9.5-13.9). Unprotected source of water (AOR = 4.7; 95% CI: 2.5-8.9), lower household water consumption (AOR = 2.8; 95% CI: 1.3-6.0), improper latrine utilization (AOR = 3.2; 95% CI: 1.5-6.7), and frequency of face washing once per day (AOR = 5.3; 95% CI: 1.2-26.6) were the factors significantly associated with active trachoma.

CONCLUSION

The current study revealed a lower overall prevalence of active trachoma (11.8%) than the WHO threshold prevalence (20%) used to declare it as a severe public health problem. All residents and health professional should collaborate on trachoma prevention by implementing the WHO SAFE strategy- surgery for trichiasis, antibiotics, facial cleanliness and environmental improvement for further trachoma elimination.

Prevalence and associations of active trachoma among rural preschool children in Wadla district, northern Ethiopia

BACKGROUND

Trachoma is a neglected eye disease and an important cause of preventable corneal blindness. In endemic areas, initial infection can occur in early childhood and following a recurrent episodes, it progresses to scarring and visual impairment. Trachoma disappeared from high income countries through enhancements of hygiene and sanitation but the disease is still a challenge in developing countries. In Ethiopia, data indicate that Amhara is the region with the highest prevalence of active trachoma. The aim of this study was to assess the prevalence and associations of active trachoma among rural preschool children in Wadla district, Amhara region, Ethiopia.

METHODS

In this study, 596 children were screened for signs of active trachoma by using cluster-sampling technique. Following pre-testing of the survey instrument in a different district, questions about socio-demographic status were delivered for heads of households. Integrated eye care workers, previously trained to undertake trachoma screening for one month, performed eye examination. The logistic regression model was used to look for associations of active trachoma.

RESULTS

The prevalence of active trachoma among rural preschool children in Wadla district was 22%. Low economic status (adjusted odds ratio [AOR]3.8 (95%CI 1.3-11.4), being 37-48 months old (4.2;1.5-12.0), living in a house with thatched roof (4.4;1.4-13.6), presence of flies in a home (4.6;2.1-9.9), once-weekly face-washing frequency (8.6;2.5-29.3), having a face that had not been washed for longer than a week (10.6;2.9-37.7), and not using soap (4.5;1.8-11.3) had association to active trachoma.

CONCLUSION

The prevalence of active trachoma among rural pre-school children in Wadla district was high. This indicates that Trachoma is still a public health problem in the district. This high prevalence calls for further interventions to prevent future trachomatis blindness.

Prevalence and risk factors of active trachoma among primary school children of Amhara Region, Northwest Ethiopia

Purpose:

Trachoma is the leading infectious cause of blindness in the world. It is caused by conjunctival infection with the bacterium Chlamydia trachomatis. The objective of this study was to determine the prevalence and risk factors of active trachoma among primary school children in Amhara region, Ethiopia.

Methods:

A cross-sectional study was conducted from April to May 2018. Data on sociodemographic and health characteristics of a child were collected using a structured questionnaire and eye examination for this study. Bivariate and multiple logistic regression statistical analyses were used to determine the prevalence and risk factors of active trachoma among primary school children living in Amhara region, Northwest Ethiopia.

Results:

The prevalence of active trachoma among primary school children living in Amhara region was 10.3% in this study. The results of multiple logistic regression analysis revealed that children who wash their face at least two times per day (AOR = 0.37, 95% CI: 0.14–0.97), children with no flies on their face (AOR = 0.12, 95% CI: 0.10–0.30) had significantly lower risk of being infected by trachoma and children of households who spend 30 min to 1 h to fetch water (AOR = 10.02, 95% CI: 1.10–93.53) had significantly higher risk of being infected by trachoma in the study area.

Conclusion:

The result of this study showed that risk factors: frequency of face washing per day, presence of flies on child's face during interview, and time required to fetch water for the household were found to be significantly associated with trachoma. Therefore, the study recommends that any concerned bodies directed at prevention and control of trachoma among primary school children living in Amhara region should give special attention to these factors. Implementing the World Health Organization (WHO) endorsed SAFE (Surgery, Antibiotics, Facial cleanliness, Environmental improvement) strategy was recommended for the effective prevention and control of trachoma in the study area since the prevalence of active trachoma, 10.3% was higher than the WHO recommended thresholds (>10% prevalence).

Prevalence and associated factors of active trachoma among 1-9 years old children in Deguatemben, Tigray, Ethiopia, 2018: community cross-sectional study

BACKGROUND

Trachoma is a contagious infection of the eye. World Health Organization recommended three rounds of mass drug administration in districts where the prevalence of trachomatous follicular (TF) is ≥10% in children aged 1-9 years. Mass drug distribution was given to residents for three consecutive years with more than 90% coverage. However, the prevalence and associated factors of active trachoma in the study community after the intervention was not yet determined. Thus, this deals with the prevalence and associated factors of active trachoma among children aged 1-9 years.

METHODS

We conducted a Community based cross-sectional study among 502 children aged 1-9 in March 2018 in Deguatemben. A multi-stage sampling technique was applied. Selected children were examined for trachoma using 2.5x binocular loupe and graded based on the WHO simplified grading system. Mothers were interviewed for factors associated with trachoma using a structured questionnaire. Data was entered on Epi-Info and exported to SPSS for analysis. Both descriptive and inferential analyses were done with 95% confidence intervals (CIs) at a p-value < 0.05 for the final model.

RESULTS

The prevalence of active trachoma was found 21.5% (95% CI: 17.8-25.1%). Being 1 to 4 years old [AOR (95% CI) = 6.81(2.00-23.11)], not washing face [AOR (95% CI) =9.31(1.13-77.66)], not using soap [AOR (95% CI) =5.84(1.87-18.21)], unclean face [AOR(95% CI) = 18.22(4.93-69.32)] and mother's knowledge [AOR (95% CI) =0.06(0.02-0.19)] were found as independent predictors.

CONCLUSION

The prevalence declined from the baseline, but it is still a public health problem in the district. Personal-related factors were found to be associated with the disease. Health education of "Facial cleanness" and related factors is recommended to increase knowledge of the mothers on their children's care in addition to the provision of antibiotics.

Prevalence and associated factors of active trachoma among children in Ethiopia: a systematic review and meta-analysis

BACKGROUND

Trachoma is the commonest infectious cause of blindness. It is prevalent in areas where personal and community hygiene is poor, and it mainly affects deprived and marginalized communities most importantly in Ethiopia. Hence, the aim of this study was to determine the prevalence and associated factors of active trachoma among children in Ethiopia.

METHOD

A systematic review and meta-analysis was employed to determine the prevalence of active trachoma and associated factors among children in Ethiopia. We searched databases, including PubMed, Google Scholar, Science Direct, EMBASE and Cochrane Library. To estimate the prevalence, studies reporting the prevalence of active trachoma and its associated factors were included. Data were extracted using a standardized data extraction format prepared in Microsoft excel and the analysis was done using STATA 14 statistical software. To assess heterogeneity, the Cochrane Q test statistics and I² test were used. Since the included studies revealed considerable heterogeneity, a random effect meta- analysis model was used to estimate the pooled prevalence of active trachoma. Moreover, the association between factors and active trachoma were examined.

RESULTS

The result of 30 eligible studies showed that the overall prevalence of active trachoma among children in Ethiopia was 26.9% (95% CI: 22.7, 31.0%). In the subgroup analysis, while the highest prevalence was reported in SNNP (35.8%; 95% CI: 22.7, 48.8), the lowest prevalence was reported in Oromia region (20.2%; 95% CI: 12.2, 28.2). Absence of latrine: OR 6.0 (95% CI 2.0, 17.5), the unclean faces of children: OR 5.5 (95% CI 2.8, 10.9), and no reported use of soap for washing: OR 3.3 (95% CI 1.8, 6.0) have shown a positive association with active trachoma among children.

CONCLUSION

From this review, it has been concluded that active trachoma among children is still a public health problem in different districts of Ethiopia. The prevalence of almost all studies are significantly higher than WHO target for elimination. Absence of latrine, unclean faces of children, no reported use of soap for washing are the important factors associated with active trachoma among children.

Prevalence of active trachoma and associated factors among children aged 1 to 9 years in rural communities of Lemo district, southern Ethiopia: community based cross sectional study

BACKGROUND

Trachoma, caused by Chlamydia trachomatis is the leading infectious cause of blindness. It is transmitted via personal contact with infected ocular and nasal secretions by hands, fomites and eye- seeking flies. Active trachoma is more common among children aged 1 to 9 years. The objective of this study was determining the prevalence of active trachoma and associated factors among children aged 1 to 9 years in rural community of Lemo district.

METHODS

Community-based cross-sectional study was conducted from March to April, 2018 in rural community of Lemo district. Multistage sampling technique was used to select 589 study participants. Data were collected by using structured pre-tested questionnaire, physical examination and observation. Binocular loupe was used to identify active trachoma cases. The data were entered by using EPi-data version 3.1 and analyzed by SPSS. Binary logistic regression was used to assess factors associated with active trachoma. Variables with p-value < 0.05 in the multivariable analysis were used to declare significance of association.

RESULT

Eighty seven (15.2%) children were positive for active trachoma. Absence of solid waste disposal pit (AOR = 2.20, 95% CI (1.12-4.37), do not use latrine as reported by respondent (AOR = 7.53, 95% CI (2.86-19.84), do not use soap for face washing as reported by respondent (AOR =2.3, 95% CI (1.32-4.12), washing face frequency as reported by respondent (AOR = 1.86, 95% CI (1.06-3.26), and family size greater than five (AOR = 1.96, 95% CI (1.06-3.67) were significantly associated with active trachoma.

CONCLUSION

Active trachoma among children aged 1 to 9 years is high. Do not use latrine, do not use soap for face washing, and face washing frequency in a day as reported by respondents and family size were associated with active trachoma. Access to adequate water and sanitation can be important components in working towards eliminating trachoma as a public health problem. Therefore, prompt measures must be taken by concerned bodies to increase access to adequate water and sanitation facilities.

Impact of a single round of mass drug administration with azithromycin on active trachoma and ocular Chlamydia trachomatis prevalence and circulating strains in The Gambia and Senegal

BACKGROUND

Mass drug administration (MDA) with azithromycin is a cornerstone of the trachoma elimination strategy. Although the global prevalence of active trachoma has declined considerably, prevalence persists or even increases in some communities and districts. To increase understanding of MDA impact, we investigated the prevalence of active trachoma and ocular C. trachomatis prevalence, organism load, and circulating strains at baseline and one-year post-MDA in The Gambia and Senegal.

METHODS

Pre- and one-year post-MDA, children aged 0-9 years were examined for clinical signs of trachoma in six Gambian and 12 Senegalese villages. Ocular swabs from each child's right conjunctiva were tested for evidence of ocular C. trachomatis infection and organism load (ompA copy number), and ompA and multi-locus sequence typing (MLST) was performed.

RESULTS

A total of 1171 children were examined at baseline and follow-up in The Gambia. Active trachoma prevalence decreased from 23.9% to 17.7%, whereas ocular C. trachomatis prevalence increased from 3.0% to 3.8%. In Senegal, 1613 and 1771 children were examined at baseline and follow-up, respectively. Active trachoma prevalence decreased from 14.9% to 8.0%, whereas ocular C. trachomatis prevalence increased from 1.8% to 3.6%. Higher organism load was associated with having active trachoma and severe inflammation. Sequence typing demonstrated that all Senegalese samples were genovar A, whereas Gambian samples were a mix of genovars A and B. MLST provided evidence of clustering at village and household levels and demonstrated differences of strain variant frequencies in Senegal, indicative of an "outbreak". MLST, including partial ompA typing, provided greater discriminatory power than complete ompA typing.

CONCLUSIONS

We found that one round of MDA led to an overall decline in active trachoma prevalence but no impact on ocular C. trachomatis infection, with heterogeneity observed between villages studied. This could not be explained by MDA coverage or number of different circulating strains pre- and post-MDA. The poor correlation between active trachoma and infection prevalence supports the need for further work on alternative indicators to clinical signs for diagnosing ocular C. trachomatis infection. MLST typing has potential molecular epidemiology utility, including better understanding of transmission dynamics, although relationship to whole-genome sequence variability requires further exploration.

Prevalence and determinants of active trachoma among preschool-aged children in Dembia District, Northwest Ethiopia

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.

Population-based prevalence survey of follicular trachoma and trachomatous trichiasis in the Casamance region of Senegal

Background

Trachoma, caused by ocular infection with Chlamydia trachomatis, is the leading infectious cause of blindness worldwide. We conducted the first population-based trachoma prevalence survey in the Casamance region of Senegal to enable the Senegalese National Eye Care Programme (NECP) to plan its trachoma control activities. The World Health Organization (WHO) guidelines state that any individual with trachomatous trichiasis (TT) should be offered surgery, but that surgery should be prioritised where the prevalence is >0.1%, and that districts and communities with a trachomatous inflammation, follicular (TF) prevalence of ≥10% in 1–9 year-olds should receive mass antibiotic treatment annually for a minimum of three years, along with hygiene promotion and environmental improvement, before re-assessing the prevalence to determine whether treatment can be discontinued (when TF prevalence in 1–9 year-olds falls <5%).

Methods

Local healthcare workers conducted a population-based household survey in four districts of the Bignona Department of Casamance region to estimate the prevalence of TF in 1–9 year-olds, and TT in ≥15 year-olds. Children’s facial cleanliness (ocular and/or nasal discharge, dirt on the face, flies on the face) was measured at time of examination. Risk factor questionnaires were completed at the household level.

Results

Sixty communities participated with a total censused population of 5580 individuals. The cluster-, age- and sex-adjusted estimated prevalence of TF in 1–9 year-olds was 2.5% (95% Confidence Interval (CI) 1.8–3.6) (38/1425) at the regional level and <5% in all districts, although the upper 95%CI exceeded 5% in all but one district. The prevalence of TT in those aged ≥15 years was estimated to be 1.4% (95%CI 1.0–1.9) (40/2744) at the regional level and >1% in all districts.

Conclusion

With a prevalence <5%, TF does not appear to be a significant public health problem in this region. However, TF monitoring and surveillance at sub-district level will be required to ensure that elimination targets are sustained and that TF does not re-emerge as a public health problem. TT surgery remains the priority for trachoma elimination efforts in the region, with an estimated 1819 TT surgeries to conduct.

[Blinding trachoma: results of a prevalence survey in 8 health districts in CAR]

Support of visual disabilities in terms of preventive and curative treatment, is a priority for public health in Central African Republic. The lack of recent and reliable data on ocular pathologies in general including trachoma particularly, has led health authorities, in collaboration with partners to undertake an epidemiological investigation to determine the mapping. This study was designed to assess the importance of endemicity in the most sensitive groups within population, including children of 1 to 9 years old. Eight from sixteen health districts in the country, were selected for this survey as a first step. The data collected will assess the real needs in medical and surgical care to develop an appropriate strategic plan of support for this condition on a large scale. This is a cross-sectional descriptive survey carried out in one month, from November 23 to December 26, 2011 in eight health prefectures of the country. The sampling frame was the population of eight health districts. The exhaustive list of villages and demographic data from the national census conducted in December 2003, adjusted by the rate of annual increase of 2.5%has been used. The administrative headquarters of the places of the visited districts leaders were excluded from the sampling frame. A random survey in clusters at two levels made from formed bases. Twenty villages (clusters) in each health district have been drawn according to the proportional probability to the size of the totals cumulative. 12,800 children of both sexes, aged 1 to 9 years have been identified in this investigation and 11,287 were actually examined, or 88.2 %, sex ratio is significantly 1.11. The proportion by age group of the children sampled is stackable to the general population. 26.9 % of TF and 5.9 % TI have been diagnosed. Six from eight districts surveyed are endemic. Three of them had respectively rates of 32.3 %, 47.1 % and 54.3 %.