Blinding Trachoma in the Northern Provinces of Vietnam—A Cross Sectional Survey

Introduction: A prevalence study was conducted in 2001 as part of the SAFE Trachoma Control initiatives in twelve districts of eight northern provinces of Vietnam. The authors present the magnitude and some risk factors of trachomatous trichiasis (TT), trachomatous scarring (TS) and trachomatous corneal opacity (TCO). Methods: Ophthalmologists examined 43,677 people of more than 34 years of age, randomly selected. Ophthalmic loupe, torchlight and the trachoma grading card recommended by WHO were used for this examination. Results: The prevalence of TT was 7.31% (95% CI 7.07–7.55) and 382,950 persons with TT were included in the study population. The rate was higher in females (8.92%) than in males (5.35%). The rate was 13.7% in the district of Me Linh in Vinh Phuc province and in the districts of Ha Tay and Khoai Chau in Hung Yen province, while in the districts of Na Ri (Bac Kan province), Cam Xuyen (Ha Tinh province) and Van Yen (Yen Bai province), the prevalence of TT was less than 2%. The TT rate in the plains was 13%, while in mountainous, coastal and delta terrains, the rate fell to 2.4%, 3.5% and 9.4% respectively. The prevalence of TS and TCO was 8.42% (95% CI 8.21–8.61) and 1.1% (95% CI 1.00–1.20) respectively. Conclusion: Although the magnitude of TT is high, the problem of TCO seems to be less serious. The goal of eliminating blinding trachoma from the study area by 2010 represents a big challenge. Based on these survey estimates, the national program could plan resources for the ‘S’ strategy of trachoma control (surgery for those at immediate risk of blindness).     

Baseline Trachoma Mapping in Malawi with the Global Trachoma Mapping Project (GTMP)

ABSTRACT

Purpose: To determine the prevalence of trachoma in all suspected endemic districts in Malawi.

Methods: A population-based survey conducted in 16 evaluation units from 12 suspected endemic districts in Malawi (population 6,390,517), using the standardized Global Trachoma Mapping Project (GTMP) protocol. A 2-stage cluster-random sampling design selected 30 households from each of 30 clusters per evaluation unit; all residents aged 1 year and older in selected households were examined for evidence of follicular trachoma (TF), intense trachomatous inflammation (TI), and trachomatous trichiasis (TT).

Results: Four of the 16 evaluation units were found to be endemic for trachoma, with a prevalence range of 10.0–13.5% for TF and 0.2–0.6% for TT. Nine evaluation units had a TF prevalence between 5.0% and 9.9% while three evaluation units had a TF prevalence <5.0%.

Conclusion: The prevalence rates of active trachoma in Malawi were not uniform among suspected endemic evaluation units, with rates higher than the World Health Organization (WHO) threshold for implementation of community-based control measures (TF?≥?10.0%) in only 4 of the 16 evaluation units. Trachoma remains a disease of public health importance in some parts of Malawi and adjoining (unmapped) districts should be prioritized for mapping. According to the survey, an additional 3,169,362 people require intervention to reduce active disease and 1557 trichiasis surgeries are needed to reduce the prevalence of TT below WHO recommended thresholds.     

Completion of Baseline Trachoma Mapping in Malawi: Results of Eight Population-Based Prevalence Surveys Conducted with the Global Trachoma Mapping Project

ABSTRACT

Purpose: Following a first phase of trachoma mapping in Malawi with the Global Trachoma Mapping Project, we identified and mapped trachoma districts previously suspected to be non-endemic, although adjacent to districts with estimated trachoma prevalences indicating a public health problem.

Methods: We conducted population-based surveys in eight evaluation units (EUs) comprising eight districts in Malawi (total population 3,230,272). A 2-stage cluster random sampling design allowed us to select 30 households from each of 30 clusters per EU; all residents aged 1 year and older in selected households were examined for evidence of trachomatous inflammation–follicular (TF) and trachomatous trichiasis (TT).

Results: None of the eight EUs had a TF prevalence in 1–9-year-olds ≥10%, one district (Dedza) had a TF prevalence between 5.0% and 9.9%, and only one district (Karonga) had a trichiasis prevalence in adults ≥0.2%.

Conclusion: The prevalence of TF and TT in six of eight EUs surveyed was consistent with an original categorization of trachoma being unlikely to be a public health problem. In the absence of formal surveys, health management information system data and other locally available information about trachoma is likely to be useful in predicting areas where public health interventions against trachoma are required.     

A Community-Based Trachoma Survey: Prevalence and Risk Factors in the Tigray Region of Northern Ethiopia

Aim: Trachoma is a public health problem in Ethiopia accounting for 35–50% of cases of blindness. This study aims to determine the prevalence of trachoma in Tigray and to evaluate whether common risk factors are also risk factors in this region. Method: A cross sectional community-based survey was conducted. From six districts, a total of 48 villages were selected by a multistage cluster random sampling technique. A total of 3900 people who were selected randomly from 1200 households were assessed for signs of trachoma. Ophthalmic nurses used a simplified clinical grading system to assess stages of trachoma while environmentalists assessed risk factors for trachoma. Results: Of the 3900 people examined, 13% had trachomatous follicles (TF), 27% intense trachomatous inflammation (TI), 17.7% trachomatous scarring (TS), 3.4% trachomatous trichiasis (TT) and 0.3% had corneal opacity (CO). The presence of a kitchen with chimney had a protective effect on TS (Adjusted Odds Ratio [AOR] = 0.82; 95% Confidence Interval [CI]: 0.65–0.96) and TT (AOR = 0.80; 95% CI: 0.53; 0.97). Active trachoma was more prevalent among children (AOR = 0.97; 95% CI: 0.96–0.97), illiterates (AOR = 1.38; 95% CI: 1.13–1.69) and those who infrequently wash their face (AOR = 1.35; 95% CI: 1.18–1.54). Conclusions: Trachoma is hyperendemic in the Tigray region. Mass chemotherapy, the expansion of primary eye care services, and promotion of a regular face washing habit are recommended. We recommend further investigations on the effect of domestic use of biomass energy on trachoma.     

Prevalence and Risk Factors for Trachoma in Rural Areas of Sistan-va-Baluchestan Province,Iran: A Population-Based Study

ABSTRACT

Purpose: To determine the prevalence of trachoma and risk factors associated with the disease in rural areas of the Sistan-va-Baluchestan province in Iran from 2012–2013. Population-based prevalence data for trachoma is lacking in this region.

Methods: In this population-based cross-sectional study, 80 clusters were selected using a systematic and probability proportional to size method. All participants underwent clinical eye examinations according to the World Health Organization simplified trachoma grading system. The prevalence of follicular trachoma (TF) in children aged 1–9 years and the prevalence of trachomatous trichiasis (TT) in women aged over 15 years were the most important clinical indicators of trachoma.

Results: The study surveyed 8187 individuals and analyzed 7912 participants (96.6%) including 3737 children aged 1–9 years and 4175 females >15 years. The prevalence of TF and TT in the relevant indicator groups were 0.59% (95% confidence interval, CI, 0.36–0.89%) and 0.02% (95% CI 0.00–0.13%), respectively.

Conclusion: Previously, trachoma prevalence data for this region were lacking. This study confirms that the Sistan-va-Baluchestan region is not endemic for trachoma. This has important implications for national trachoma elimination activities.     

Mapping Trachoma in the Solomon Islands: Results of Three Baseline Population-Based Prevalence Surveys Conducted with the Global Trachoma Mapping Project

ABSTRACT

Purpose: We sought to complete the baseline trachoma map of the Solomon Islands by establishing prevalences of active trachoma and trichiasis in the provinces of Choiseul, Western, Rennell-Bellona, and Temotu.

Methods: Using the standardized methodology developed for the Global Trachoma Mapping Project, we conducted cross-sectional community-based surveys from September to November 2013. Choiseul and Western provinces were each mapped as separate evaluation units (EUs); Rennell-Bellona and Temotu were combined to form a third EU.

Results: A total of 9819 individuals were sampled for inclusion, with 9224 (93.3%) consenting to examination, of whom 4587 (46.3%) were female. Survey teams visited 82 villages, and surveyed 2448 households. Two EUs had prevalences of trachomatous inflammation – follicular (TF) in 1–9-year-olds over the 10% threshold at which WHO recommends mass distribution of azithromycin for at least 3 years (Western 20.4%, 95% confidence interval, CI 15.6–26.3%; Rennell-Bellona/Temotu 22.0%, 95% CI 18.5–26.0%). Choiseul had a TF prevalence of 6.1% (95% CI 4.1–8.6%), and met the criterion for a single round of mass antibiotic distribution before re-survey. The adjusted prevalences of trichiasis in those aged 15+ years were 0.0% (95% CI 0.0–0.2%) in Choiseul, 0.16% (95% CI 0.0–0.5%) in Western, and 0.10% (95% CI 0–0.3%) in Rennell-Bellona/Temotu provinces. All three EUs require implementation of the facial cleanliness and environmental improvement components of the trachoma elimination strategy.

Conclusion: Active trachoma is prevalent in the Solomon Islands. However, there is little evidence of the blinding complications of trachoma being a public health problem there. Further research into the explanation for this phenomenon is warranted.     

The Epidemiology of Trachoma in the Five Northern Districts of Sierra Leone

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.     

Prevalence of Trachoma in Katsina State,Nigeria: Results of 34 District-Level Surveys

ABSTRACT

Purpose: To determine the local government area (LGA)-level prevalence of trachoma in all 34 LGAs of Katsina State.

Methods: A population-based prevalence survey was conducted in each LGA of Katsina State, using the Global Trachoma Mapping Project methodology. We used a 3-stage cluster random sampling strategy to select 25 households from each of 25 clusters. We examined all residents of selected households aged 1 year and older for the clinical signs of trachomatous inflammation–follicular (TF), trachomatous inflammation–intense and trichiasis, using the World Health Organization (WHO) simplified grading scheme.

Results: We examined 129,281 persons. Six LGAs had a TF prevalence ≥10%, and another six LGAs had a TF prevalence between 5% and 9.9%; all 12 require mass drug administration with azithromycin plus other interventions. The prevalence of trichiasis was ≥1.0% in 13 LGAs, and there is a need to perform trichiasis surgery in over 26,000 persons to reach targets set by the WHO for elimination of trichiasis.

Conclusion: The prevalence of TF is generally low in Katsina state, but urgent steps must be taken to implement the full SAFE strategy (surgery, antibiotics, facial cleanliness, environmental improvement) in at least 12 LGAs while also stepping up efforts to provide community-based trichiasis surgery throughout the whole state, in order to make trachoma elimination by 2020 a reality.     

Inter-Rater Agreement between Trachoma Graders: Comparison of Grades Given in Field Conditions versus Grades from Photographic Review

ABSTRACT

Purpose: Trachoma surveillance is most commonly performed by direct observation, usually by non-ophthalmologists using the World Health Organization (WHO) simplified grading system. However, conjunctival photographs may offer several benefits over direct clinical observation, including the potential for greater inter-rater agreement. This study assesses whether inter-rater agreement of trachoma grading differs when trained graders review conjunctival photographs compared to when they perform conjunctival examinations in the field.

Methods: Three trained trachoma graders each performed an independent examination of the everted right tarsal conjunctiva of 269 children aged 0–9 years, and then reviewed photographs of these same conjunctivae in a random order. For each eye, the grader documented the presence or absence of follicular trachoma (TF) and intense trachomatous inflammation (TI) according to the WHO simplified grading system.

Results: Inter-rater agreement for the grade of TF was significantly higher in the field (kappa coefficient, κ, 0.73, 95% confidence interval, CI 0.67–0.80) than by photographic review (κ?=?0.55, 95% CI 0.49–0.63; difference in κ between field grading and photo grading 0.18, 95% CI 0.09–0.26). When field and photographic grades were each assessed as the consensus grade from the three graders, agreement between in-field and photographic graders was high for TF (κ?=?0.75, 95% CI 0.68–0.84).

Conclusions: In an area with hyperendemic trachoma, inter-rater agreement was lower for photographic assessment of trachoma than for in-field assessment. However, the trachoma grade reached by a consensus of photographic graders agreed well with the grade given by a consensus of in-field graders.     

Assessment of Trachoma in Cambodia: Trachoma Is Not a Public Health Problem

ABSTRACT

Purpose: To determine whether trachoma is a public health problem requiring intervention in Cambodia.

Methods: Based on historical evidence and reports, 14 evaluation units (EUs) in Cambodia, judged to be most likely to harbor trachoma, were selected. The Global Trachoma Mapping Project methodology was used to carry out rigorous surveys to determine the prevalence of trachomatous inflammation–follicular (TF) and trichiasis in each EU.

Results: The EU-level prevalence of TF among 25,801 1–9-year-old children examined ranged from 0% to 0.2%. Among the 24,502 adults aged 15+ years examined, trichiasis was found in 59 people. Age- and sex-adjusted prevalences of trichiasis in all ages in the EUs studied ranged from 0% to 0.14%; five EUs had a prevalence of trichiasis ≥0.1%.

Conclusions: There appears to be no need nor justification at this time for implementing public health measures to control trachoma in Cambodia.     

A community-based trachoma survey: prevalence and risk factors in the Tigray region of northern Ethiopia

AIM: Trachoma is a public health problem in Ethiopia accounting for 35-50% of cases of blindness. This study aims to determine the prevalence of trachoma in Tigray and to evaluate whether common risk factors are also risk factors in this region. METHOD: A cross sectional community-based survey was conducted. From six districts, a total of 48 villages were selected by a multistage cluster random sampling technique. A total of 3900 people who were selected randomly from 1200 households were assessed for signs of trachoma. Ophthalmic nurses used a simplified clinical grading system to assess stages of trachoma while environmentalists assessed risk factors for trachoma. RESULTS: Of the 3900 people examined, 13% had trachomatous follicles (TF), 27% intense trachomatous inflammation (TI), 17.7% trachomatous scarring (TS), 3.4% trachomatous trichiasis (TT) and 0.3% had corneal opacity (CO). The presence of a kitchen with chimney had a protective effect on TS (Adjusted Odds Ratio [AOR] = 0.82; 95% Confidence Interval [CI]: 0.65-0.96) and TT (AOR = 0.80; 95% CI: 0.53; 0.97). Active trachoma was more prevalent among children (AOR = 0.97; 95% CI: 0.96-0.97), illiterates (AOR = 1.38; 95% CI: 1.13-1.69) and those who infrequently wash their face (AOR = 1.35; 95% CI: 1.18-1.54). CONCLUSIONS: Trachoma is hyperendemic in the Tigray region. Mass chemotherapy, the expansion of primary eye care services, and promotion of a regular face washing habit are recommended. We recommend further investigations on the effect of domestic use of biomass energy on trachoma.     

Community-level Association between Clinical Trachoma and Ocular Chlamydia Infection after MASS Azithromycin Distribution in a Mesoendemic Region of Niger

Purpose: The clinical sign trachomatous inflammation – follicular (TF) is used to monitor indication for and response to mass azithromycin distribution in trachoma-endemic communities. Here, we assess the relationship between TF, trachomatous inflammation – intense (TI), and infection with ocular Chlamydia trachomatis over time during annual mass azithromycin distribution.

Methods: We used data from a cluster-randomized trial of mass azithromycin distribution for trachoma control in a mesoendemic region of Niger. This study includes 24 communities that received 3 years of annual mass azithromycin distribution. TF, TI, and ocular chlamydia infection were monitored among children aged 0–5 years. We assessed the correlation between the prevalence of ocular chlamydia infection and 1) TF and 2) TI prevalence over time.

Results: At baseline, ocular chlamydia prevalence was 21.2% (95% CI 14.3–28.1%), TF prevalence was 27.7% (95% CI 21.2–34.2%), and TI prevalence was 8.3% (95% CI 5.2–11.5%). The prevalence of all three measures decreased significantly over time (P < 0.001). At baseline, ocular chlamydia infection prevalence was strongly correlated with both TF (rho = 0.78, P < 0.0001) and TI (rho = 0.76, P < 0.0001). The correlation between ocular chlamydia infection and both TF and TI was weak at months 12 and 24. At 36 months, when TF prevalence had dropped below 10%, ocular chlamydia infection and TF were moderately correlated (rho = 0.70, P= 0.0002).

Conclusions: Both TF and TI are good indicators of infection prevalence prior to mass azithromycin distribution. However, this relationship may be affected by repeated rounds of mass azithromycin distribution.     

National Trachoma Assessment in the Lao People’s Democratic Republic in 2013–2014

ABSTRACT

Purpose: Population-based prevalence surveys were undertaken to determine whether trachoma is a public health problem in Laos requiring implementation of the SAFE strategy (surgery, antibiotics, facial cleanliness, environmental improvement).

Methods: The country was divided into 19 evaluation units (EUs), each containing a population of roughly 100,000–350,000 people. Of these, 16 were believed most likely to harbor trachoma (based on historical evidence), and were mapped using the Global Trachoma Mapping Project methods. A 2-stage cluster sampling was used to sample approximately 1222 children aged 1–9 years in each EU, as well as all adults aged 15 years and older resident in households with children. The presence or absence of trachomatous inflammation – follicular (TF) and of trichiasis was documented in each subject, and prevalences (adjusted for age and sex) estimated.

Results: The adjusted prevalence of TF in 1–9-year-olds ranged from 0.2% to 2.2% across the 16 EUs. Adjusted all-ages prevalence of trichiasis was 0.00% in 13 EUs, 0.06% in two EUs, and 0.12% in one EU. The trichiasis prevalence in adults in the last EU was 0.19%.

Conclusions: The assessment included all areas of Laos suspected of ever harboring trachoma and most of the rural population of the country. The low prevalence of TF and trichiasis do not warrant any special programs against trachoma at this time.     

Prevalence of Trachoma in Bauchi State,Nigeria: Results of 20 Local Government Area-Level Surveys

ABSTRACT

Purpose: To determine the prevalence of trachomatous inflammation – follicular (TF) and trichiasis in each of the 20 local government areas (LGAs) of Bauchi State, Nigeria.

Methods: We undertook a population-based prevalence survey in each LGA in Bauchi State, employing the Global Trachoma Mapping Project methodology. We used a 2-stage, systematic and quasi-random sampling strategy. Using probability proportional to size, we selected 25 clusters, in each of which 25 households were selected by random walk. All residents of selected households 1 year and older were examined for TF, trachomatous inflammation – intense, and trichiasis, using the World Health Organization simplified grading scheme.

Results: Only two LGAs in Bauchi State had TF prevalences in 1–9-year-olds over 5%, with none having TF prevalences of 10% or greater. Only one LGA had a trichiasis prevalence in adults below the elimination threshold; all the others had trichiasis at levels suggestive of public health significance. In all 20 LGAs, more than 60% of households were within 1 km of an improved source of water for hygiene.

Conclusion: Efforts need to be made in Bauchi State to provide trichiasis surgery in order to avert trachomatous blindness. Water supplies needs to be sustained and good personal hygiene practices assured so that elimination of trachoma as a public health problem will be achieved and sustained.     

Prevalence of Trachoma in Niger State,North Central Nigeria: Results of 25 Population-Based Prevalence Surveys Carried Out with the Global Trachoma Mapping Project

ABSTRACT

Purpose: To determine the prevalence of trachoma in each of the 25 local government areas (LGAs) of Niger State, Nigeria.

Methods: A population-based cross-sectional survey was conducted in each Niger State LGA between March and April 2014, as part of the Global Trachoma Mapping Project (GTMP). GTMP protocols were used in planning and conduct of the surveys. Using probability proportional to size, 25 clusters were selected; in each of these clusters, 25 households were enrolled for the survey. All residents aged 1 year and older were examined by GTMP-certified graders for trachomatous inflammation – follicular (TF) and trichiasis using the World Health Organization simplified grading scheme. Additionally, we collected data on household water and sanitation facilities.

Results: Only one LGA (Kontagora) had TF prevalence in 1–9-year-olds above 10%; one other LGA (Rafi) had TF prevalence between 5.0 and 9.9%. Six LGAs need trichiasis surgical services provided to achieve a prevalence of <1 case of trichiasis per 1000 total population. The proportion of households with access to improved water sources ranged from 23 to 100%, while household-level access to improved latrines ranged from 8 to 100% across the LGAs.

Conclusion: The prevalence of trachoma is relatively low in most of Niger State. There is a need for community-based trichiasis surgical services in a small number of LGAs. The trachoma elimination program could engage water and sanitation agencies to augment access to improved water and sanitation facilities, for human rights reasons. Kontagora and Rafi need community-based interventions to reduce the prevalence of active trachoma.     

Mapping Trachoma in Kaduna State,Nigeria: Results of 23 Local Government Area-Level,Population-Based Prevalence Surveys

ABSTRACT

Introduction: To prepare for global elimination of trachoma by 2020, the World Health Organization (WHO) recommends mapping of trachoma at district-level to enable planning of elimination activities in affected populations. The aim of our study was to provide data on trachoma for each local government area (LGA) of Kaduna State, Nigeria, as such data were previously unavailable.

Method: As part of the Global Trachoma Mapping Project (GTMP), a population-based cross-sectional trachoma survey was conducted in each of the 23 LGAs of Kaduna State, between May and June 2013. The protocols of the GTMP were used.

Results: The prevalence of trachomatous inflammation – follicular (TF) in children aged 1–9 years was between 0.03% and 8% across the LGAs, with only one LGA (Igabi) having a TF prevalence ≥5%. The LGA-level prevalences of trichiasis in persons aged 15 years and older were between 0.00% and 0.78%. Eleven LGAs had trichiasis prevalences of 0.2% and over in adults; a threshold equivalent to 1 case per 1000 total population. The LGA-level proportion of households with access to improved water sources ranged from 9% to 96%, while household access to latrines ranged from 5% to 99%.

Conclusion: Kaduna State has generally hypoendemic trachoma, but a few trichiasis surgeries are still required to attain the WHO elimination targets. Better access to improved water and sanitation is needed.     

Trachoma among adults in Damot Gale District,South Ethiopia

PURPOSE To determine the prevalence of trachoma and its risk factors among adults in the Damot Gale District of south Ethiopia. METHODS A cross-sectional, community based survey was conducted in the Damot Gale District of south Ethiopia. A multi-stage sampling method was used to select subjects. RESULTS Out of 924 eligible subjects, 855 were examined, for a response rate of 92.5%. Active trachoma [follicles (TF), intense inflammation (TI) or TF/TI] was found in 20.6% (95% CI: 17.8–23.4%) of the subjects. The prevalence of trachomatous trichiasis (TT) and corneal opacity (CO) was 6.8% (95% CI: 5.1–8.5%) and 2.1% (95% CI: 1.0–3.1%), respectively. Females were affected by active trachoma twice as often as males [OR 2.13 (95% CI: 1.67–3.50, P &lt; 0.0001)]. The prevalence of blinding trachoma (TT and CO) was also significantly higher among females [OR 3.03 (95% CI: 1.58–5.89, P &lt; 0.001)]. Literacy and face washing were found to be significantly associated with less prevalence of active trachoma. CONCLUSION The prevalence of both active and cicatricial trachoma among adults residing in the Damot Gale District of south Ethiopia is very high. Although children are the main reservoirs of active trachoma, intervention strategies should address the fact that a high prevalence of active trachoma is also found among adults residing in hyperendemic areas.     

Population-Based Survey of Active Trachoma in 11 Districts of Burundi

Purpose: To establish that trachoma is a public health problem in Burundi, and to provide baseline data on the prevalence of active trachoma and unclean faces prior to the commencement of trachoma elimination activities in endemic districts.

Methods: For each of 11 pilot districts, eight collines (hills) (estimated population generally 1000–8000) were selected at random using a population-proportional-to-size technique; from each selected colline, one sous-colline (of which there are generally 3–5 per colline) was selected at random by simple random draw. In each selected sous-colline, all available 1–9-year-old children were examined for clinical signs of trachoma, and for signs of an unclean face (defined as eye discharge, nose discharge and/or presence of one or more flies on the face during the time taken to examine the eyes).

Results A mean of 230 children were examined per sous-colline (range 44–600); in all, 20,659 children were examined in 90 sous-collines of 11 districts. (In one district, 10 rather than eight sous-collines were selected.) In three contiguous districts (Buhiga, Nyabikere and Muyinga) in the country’s north-east, the prevalence of the sign “trachomatous inflammation-follicular” (TF) in 1–9-year-olds was >10%. In nine districts, the prevalence of unclean faces was >10%.

Conclusion: Trachoma is a public health problem in Burundi. Implementation of trachoma control activities is indicated in at least Buhiga, Nyabikere and Muyinga. Further work should be carried out to establish the likely backlog of unoperated trachomatous trichiasis.     

Prevalence of Trachoma in Kano State,Nigeria: Results of 44 Local Government Area-Level Surveys

Purpose: We sought to determine the prevalence of trachoma in 44 Local Government Areas (LGAs) of Kano State, Nigeria.

Methods: A population-based prevalence survey was conducted in each Kano LGA. We used a two-stage systematic and quasi-random sampling strategy to select 25 households from each of 25 clusters in each LGA. All consenting household residents aged 1 year and above were examined for trachomatous inflammation–follicular (TF), trachomatous inflammation–intense (TI) and trichiasis.

Results: State-wide crude prevalence of TF in persons aged 1–9 years was 3.4% (95% CI 3.3–3.5%), and of trichiasis in those aged ≥15 years was 2.3% (95% CI 2.1–2.4%). LGA-level age- and sex-adjusted trichiasis prevalence in those aged ≥15 years ranged from 0.1% to 2.9%. All but 4 (9%) of 44 LGAs had trichiasis prevalences in adults above the elimination threshold of 0.2%. State-wide prevalence of trichiasis in adult women was significantly higher than in adult men (2.6% vs 1.8%; OR = 1.5, 95% CI 1.3–1.7; p = 0.001). Four of 44 LGAs had TF prevalences in 1–9-year-olds between 10 and 15%, while another six LGAs had TF prevalences between 5 and 9.9%. In 37 LGAs, >80% of households had access to water within 30 minutes round-trip, but household latrine access was >80% in only 19 LGAs.

Conclusion: Trichiasis is a public health problem in most LGAs in Kano. Surgeons need to be trained and deployed to provide community-based trichiasis surgery, with emphasis on delivery of such services to women. Antibiotics, facial cleanliness and environmental improvement are needed in 10 LGAs.     

Prevalence of Trachoma in Gambella Region,Ethiopia: Results of Three Population-Based Prevalence Surveys Conducted with the Global Trachoma Mapping Project

ABSTRACT

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.