Epidemiological assessment of a large geographical area with clustered trachoma: The Upper Eastern Kenya survey (original) (raw)
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The American Journal of Tropical Medicine and Hygiene, 2019
At baseline in 2006, Amhara National Regional State, Ethiopia, was the most trachoma-endemic region in the country. Trachoma impact surveys (TIS) were conducted in all districts between 2010 and 2015, following 3-5 years of intervention with the WHO-recommended SAFE (surgery, antibiotics, facial cleanliness, and environmental improvement) strategy. A multistage cluster random sampling design was used to estimate the district-level prevalence of trachoma. In total, 1,887 clusters in 152 districts were surveyed, from which 208,265 individuals from 66,089 households were examined for clinical signs of trachoma. The regional prevalence of trachomatous inflammation-follicular (TF) and trachomatous inflammation-intense among children aged 1-9 years was 25.9% (95% CI: 24.9-26.9) and 5.5% (95% CI: 5.2-6.0), respectively. The prevalence of trachomatous scarring and trachomatous trichiasis among adults aged ³ 15 years was 12.9% (95% CI: 12.2-13.6) and 3.9% (95% CI: 3.7-4.1), respectively. Among children aged 1-9 years, 76.5% (95% CI: 75.3-77.7) presented with a clean face; 66.2% (95% CI: 64.1-68.2) of households had access to water within 30 minutes round-trip, 48.1% (95% CI: 45.5-50.6) used an improved water source, and 46.2% (95% CI: 44.8-47.5) had evidence of a used latrine. Nine districts had a prevalence of TF below the elimination threshold of 5%. In hyperendemic areas, 3-5 years of implementation of SAFE is insufficient to achieve trachoma elimination as a public health problem; additional years of SAFE and several rounds of TIS will be required before trachoma is eliminated.
Ophthalmic Epidemiology, 2016
Purpose: Based on health care records and trachoma rapid assessments, trachoma was suspected to be endemic in Kaskazini A and Micheweni districts of Zanzibar. This study aimed to investigate the prevalence of trachomatous inflammation-follicular (TF), and trachomatous trichiasis (TT) in each of those districts. Methods: The survey was undertaken in Kaskazini A and Micheweni districts on Unguja and Pemba Islands, respectively. A multi-stage cluster random sampling design was applied, whereby 25 census enumeration areas (clusters) and 30 households per cluster were included. Consenting eligible participants (children aged 1-9 years and people aged 15 years and older) were examined for trachoma using the World Health Organization simplified grading system. Results: A total of 1673 households were surveyed and 6407 participants (98.0% of those enumerated) were examined for trachoma. Examinees included a total of 2825 children aged 1-9 years and 3582 people aged 15 years and older. TF prevalence in 1-9-year-olds was 2.7% (95% confidence interval, CI, 2.7-4.1%) in Kazkazini A and 11.4% (95% CI 6.6-16.5%) in Micheweni. Among people aged 15 years and older, TT prevalence was 0.01% (95% CI 0.00-0.04%) in Kazkazini A and 0.21% (95% CI 0.08-0.39%) in Micheweni. Conclusion: Trachoma is a public health problem in Micheweni district, where implementation of all four components of the SAFE strategy (surgery, antibiotics, facial cleanliness, and environmental improvement), including mass drug administration with azithromycin, is required. These findings will facilitate planning for trachoma elimination.
Trachoma prevalence and risk factors in eight local government areas of Zamfara State
Nigerian Journal of Ophthalmology, 2015
an ambitious plan of eliminating trachoma as a disease of public health significance by the year 2020 (Global Elimination of Trachoma by 2020-GET 2020). Zamfara state government in collaboration with an NGDO has been implementing a trachoma control program since 2003 that was integrated into the Zamfara state eye care program in 2010. The program implements community-based lid surgery for trachomatous trichiasis (TT), environmental improvement, and mass antibiotic (Zithromax) distribution, which are part of the WHO-recommended SAFE strategy for trachoma control (S-surgery, A-Antibiotics, F-facial cleanliness, and E-Environmental improvement). Previous trachoma surveys in some local government areas (LGAs) of
PLoS Neglected Tropical Diseases, 2013
Background: Cameroon is known to be endemic with trachoma. To appreciate the burden of the disease and facilitate the national planning of trachoma control in the integrated control program for the neglected tropical diseases, an epidemiological mapping of trachoma was conducted in the Far North region in 2010-11. Methodology: A cross-sectional, cluster random sampling survey was carried out. The survey focused on two target populations: children aged 1 to 9 years for the prevalence of active trachoma and those aged 15 and over for the prevalence of trichiasis (TT). The sample frame was an exhaustive list of villages and neighborhoods of Health Districts (HDs). The World Health Organization simplified trachoma grading system was used for the recognition and registration of cases of trachoma.
Prevalence of Trachoma in the North Region of Cameroon: Results of a Survey in 15 Health Districts
PLoS Neglected Tropical Diseases, 2014
Background: To estimate the prevalence of trachoma in the North Region of Cameroon in order to facilitate the planning of trachoma control activities in this region, a survey was carried out in 2011 and 2012 in 15 health districts (HDs). Methodology: A cross-sectional, two-stage cluster random sampling survey was carried out. The survey focused on two target populations: children aged 1 to 9 years for the prevalence of Trachomatous Inflammation-Follicular (TF) and those aged 15 and over for the prevalence of Trachomatous Trichiasis (TT). The sample frame was an exhaustive list of villages and neighborhoods of HDs. The World Health Organization simplified trachoma grading system was used for the recognition and registration of cases of trachoma. Principal Findings: 30,562 children aged 1 to 9 years and 24,864 people aged 15 and above were examined. In children aged 1-9 years, the overall prevalence of TF was 4.2% (95% confidence intervals (CI): 4.0-4.5%). Three (3) of 15 HDs in the region showed TF prevalence of 1010% (Poli, Rey Bouba, and Tcholliré). The overall TT prevalence was 0.25% (95% CI: 0.20-0.33%). There were estimated 1265 TT cases in the region. The prevalence of blindness was 0.01% (95% CI: 0.00-0.03%), low vision was 0.11% (95% CI: 0.07-0.17%), and corneal opacity was 0.22% (95% CI: 0.17-0.29%). Conclusions/Significance: This survey provides baseline data for the planning of activities to control trachoma in the region. The overall prevalence of TF in the region is 4.2%, and that of TT is 0.2%; three HDs have a TF prevalence 1010%. These three HDs are eligible for mass drug administration with azythromycin, along with the implementation of the ''F'' and ''E'' components of the SAFE strategy.
Ophthalmic Epidemiology, 2016
Purpose: We sought to estimate the prevalence of trachoma at sufficiently fine resolution to allow elimination interventions to begin, where required, in the Southern Nations, Nationalities, and Peoples' Region (SNNPR) of Ethiopia. Methods: We carried out cross-sectional population-based surveys in 14 rural zones. A 2-stage cluster randomized sampling technique was used. A total of 40 evaluation units (EUs) covering 110 districts ("woredas") were surveyed from February 2013 to May 2014 as part of the Global Trachoma Mapping Project (GTMP), using the standardized GTMP training package and methodology. Results: A total of 30,187 households were visited in 1047 kebeles (clusters). A total of 131,926 people were enumerated, with 121,397 (92.0%) consenting to examination. Of these, 65,903 (54.3%) were female. In 38 EUs (108 woredas), TF prevalence was above the 10% threshold at which the World Health Organization recommends mass drug administration with azithromycin annually for at least 3 years. The region-level age-and sex-adjusted trichiasis prevalence was 1.5%, with the highest prevalence of 6.1% found in Cheha woreda in Gurage zone. The region-level ageadjusted TF prevalence was 25.9%. The highest TF prevalence found was 48.5% in Amaro and Burji woredas. In children aged 1-9 years, TF was associated with being a younger child, living at an altitude <2500m, living in an area where the annual mean temperature was >15°C, and the use of open defecation by household members. Conclusion: Active trachoma and trichiasis are significant public health problems in SNNPR, requiring full implementation of the SAFE strategy (surgery, antibiotics, facial cleanliness, and environmental improvement).
Ophthalmic Epidemiology, 2018
Purpose: Ethiopia is highly trachoma endemic. Baseline mapping was needed in Ethiopia's Somali Region to guide elimination efforts. Methods: Cross-sectional community-based surveys were conducted in 34 suspected trachomaendemic woredas, grouped as 14 evaluation units (EUs), using a standardised mapping methodology developed for the Global Trachoma Mapping Project. Results: In total, 53,467 individuals were enumerated. A total of 48,058 (89.9%) were present at the time of survey teams' visits and consented to examination. The prevalence of trachomatous inflammation-follicular (TF) among children aged 1-9 years ranged from 4.1% in the EU covering Danot, Boh, and Geladin woredas in Doolo Subzone to 38.1% in the EU covering Kebribeyah and Hareshen woredas in Fafan Subzone (East). The trichiasis prevalence among adults aged over 15 years varied from 0.1% in the EU covering Afder, Bare, and Dolobay woredas in Afder Subzone (West) to 1.2% in the EU covering Awbere in Fafan Subzone (West). Conclusion: Mass drug administration (MDA) with azithromycin is needed in 13 EUs (population 2,845,818). Two EUs (population 667,599) had TF prevalences in 1-9-year-olds of ≥30% and will require at least 5 years of MDA; 5 EUs (population 1,1193,032) had TF prevalences of 10-29.9% and need at least three years of MDA; 6 EUs (population 985,187) had TF prevalences of 5-9.9% and need at least one round of azithromycin distribution before re-survey. In all 13 of these EUs, implementation of facial cleanliness and environmental improvement measures is also needed. Surveys are still needed in the remaining 34 unmapped woredas of Somali Region.
Ophthalmic Epidemiology, 2016
Purpose: In Ethiopia, trachoma is a major public health problem, accounting for 11.5% of all cases of blindness. In Gambella, one of the country's most remote regions, the 2005-2006 National Survey of Blindness, Low Vision and Trachoma estimated a region-level prevalence of active trachoma of 19.1% in those aged 1-9 years. Detailed district or sub-regional level estimates are required to implement interventions. Methods: Population-based prevalence surveys were carried out following a 2-stage cluster random sampling methodology and Global Trachoma Mapping Project protocols. As the 13 districts (woredas) in Gambella had relatively small populations, they were grouped together to form three evaluation units (EUs) of about 100,000 persons each, and all subsequent survey planning and sampling was carried out at EU-level. Results: Altogether, 558 cases of TF (17.2%) were identified in 3238 children aged 1-9 years across the three EUs. The adjusted TF prevalences in 1-9-year-olds for the three EUs were 11.5%, 12.5% and 19.3%; 14.4% for Gambella overall. A total of 142 cases of trichiasis (3.8%) were identified among 3781 adults aged 15 years or older, with age-and sex-adjusted EU-level trichiasis prevalences in adults being 0.8%, 1.3% and 2.4%; 1.5% overall. Conclusion: The high prevalences of TF and trichiasis throughout Gambella indicate a need for rapid scaling up of the World Health Organization SAFE strategy (surgery, antibiotics, facial cleanliness, and environmental improvement) to help meet the 2020 target of global elimination of trachoma as a public health problem.