Rapid Trachoma Assessment in Kersa District,Southwest Ethiopia

Background

Trachoma is the leading cause of infectious blindness worldwide. Though trachoma can be treated with antibiotics (active trachoma) or surgery (trachomatous trichiasis), it is still endemic in most parts of Ethiopia. Despite the prevalence of this infectious disease in different parts of the country, district level data is lacking. This study was thus conducted to assess the prevalence estimate of trachoma and its risk factors in Kersa District, Southwest Ethiopia.

Methods

A community based cross sectional Rapid Assessment of Trachoma was conducted using a WHO guideline. Six sub-districts were selected from Kersa District based on primary high risk assessment and from each sub-district; 21–27 households were randomly selected. Active trachoma for children aged 1–9 years, trachomatous trichiasis for people above 15 years old and environmental risk factors for trachoma were assessed. Data were analyzed using SPSS version 16.

Results

The overall prevalence estimate of active trachoma was 25.2% (95% CI: 20.7–30.4%). Forty three percent of children had unclean faces, 11.5% of households had water source at more than half hour walking distance, 18.2% did not have functional latrine, and 95.3% of the households had solid waste disposal within a distance of 20 meters. Households with environmental risk factors were at an increased risk to active trachoma, but the association was not statistically significant (p>0.05). The prevalence estimate of trachomatous trichiasis inclusive of “trachoma suspects” was 4.5%.

Conclusion

Trachoma is endemic in Kersa District with active trachoma being a public health problem in the studied sub-districts. Hence, SAFE strategy should be implemented.     

Trichiasis and geoclimatic factors in Mali

Several trachoma surveys conducted in sub-Saharan countries showed different geographical distributions of active trachoma and trichiasis. Trichiasis is more common in southern regions. We analysed the role of geoclimatic factors in determining the distributions of active trachoma and trichiasis in Mali. In each region a random sample of 30 clusters was examined. The prevalence of active trachoma among children and of trichiasis among women was compared, and geographical, environmental and social risk factors were assessed. Logistic regression models were constructed. Multiple regression analysis was applied and models were used to map the probability of active trachoma and trichiasis. The highest prevalence rates of active trachoma (TF/TI) were found in the northern part of Mali reaching 41.1% among children living north of the 15th parallel. Surprisingly, prevalence rates of trichiasis (TT) among women regularly increased from north to south (1.0% north of the 15th parallel vs. 2.8% south; OR=2.91, 95% CI 2.01-4.24). The two related predictive maps showed a gradient SSE/NNW for TF/TI very different from the gradient NS/SW for TT. These opposite spatial distributions could be explained by differences in the pathogenic agent, the natural history of the disease, population susceptibility, grading process or vulnerable group behaviour.     

The epidemiology of trachoma in central Tanzania.

Trachoma is the leading infectious cause of blindness worldwide and data are needed on the epidemiological characteristics of active and residual disease in hyperendemic areas. This study describes the epidemiological characteristics of trachoma in Central Tanzania. Active, inflammatory disease peaks in pre-school children, with 60% showing signs of trachoma. Evidence of past infection, scarring, trichiasis, and corneal opacity, rose with age. In this population, 8% of those over age 55 had trichiasis/entropion. Females of all ages had more trachoma than males, with a fourfold increased risk of trichiasis observed in females. Women who were taking care of children appeared to have more active disease than non-caretakers. Clear evidence of clustering of trachoma by village, and within village, by neighbourhood was found. Clustering persisted even after accounting for differences in distance to water, local religion, and proportion of children with unclean faces. These findings have important implications for a trachoma control strategy.     

Cartography of trachoma in Mali: results of a national survey

Prior to a campaign to eliminate blinding trachoma, a survey of the prevalence of the disease was conducted in the seven administrative regions of Mali between March 1996 and June 1997. In each region (with the exception of Bamako District) a random sample of thirty clusters was taken from the general population, in accordance with the principle of probability proportionate to the size of the communities. All children under 10 years of age and all women over 14 years were examined. The simplified coding proposed by WHO was used for data gathering. A total of 15,310 children and 11,530 women were examined. The prevalence of active trachoma, follicular (TF) or intense (TI), was estimated to be 34.9% among children under 10 years of age (95% CI: 32.3-37.6). The prevalence of TI showing the intensity of trachoma was 4.2% (95% CI: 3.5-5.0) among the same children. The prevalence increased up to the age of 3 years, when it reached 49.2%. The prevalence of TF/TI was 35.7% among boys and 34.3% among girls. The prevalence of entropion trichiasis among women over 14 years of age was 2.5% (95% CI: 2.1-2.9), and 1% had central corneal opacity (95% CI: 0.8-1.3). These prevalences increased with age, such that 10% of women over 70 years of age had trichiasis. By region of the country, the prevalence ranged from 23.1% of active trachoma among children in Ségou, to 46.2% in Gao. The prevalence of entropion trichiasis was 0.65% in Gao region and 3.9% in Koulikoro region. This survey allows the trachoma treatment needs of Mali to be quantified. We estimate that 1.09 million children under 10 years are carriers of active trachoma and require local or general antibiotic treatment. If all the under-10-year-olds from all villages where TF/TI exceeded 20% were to be treated, a total of 2.436 million children would be involved. A total of 85,000 adults should have surgery to correct trichiasis and avoid the onset of blindness.     

Incidence of trichiasis in a cohort of women with and without scarring

BACKGROUND: Blindness from trachoma is a significant problem for many underdeveloped countries. While active trachoma is common in children, trichiasis, the potentially blinding sequella, develops in adulthood and affects mainly women. Little is known about factors associated with the development of trichiasis. METHODS: The 7-year incidence of trichiasis and its association with ocular chlamydia infection was examined in a cohort of women from a hyperendemic area. A total of 4,932 women 18 years and older, living in 11 villages in Central Tanzania, were examined in 1989. A follow-up examination in 1996 was performed on all women with scars living in six of the 11 villages and on a random sample of women without scars from the same villages. Trachoma was graded clinically, chlamydia infection was ascertained at follow-up using polymerase chain reaction-enzyme immunoassay (PCR-EIA). RESULTS: A total 523 of the women with scars and 503 of the women without scars were re-examined. Forty-eight of the women with scars (incidence, 9.2%) and three of the women without scars (0.6%) developed trichiasis in the 7-year period. Prevalence of chlamydia infection was significantly higher in the group with scars (11.7% versus 7.1%). Trichiasis cases were more likely to be older, and to have chlamydia infection at follow-up odds ratio (95% confidence interval) 2.5 (1.1-5.7). CONCLUSION: The 7-year incidence rate in the population with scars was high, over 1% per year. Ocular chlamydia infection was more common in the group with scars at baseline and was also associated with being a trichiasis case, suggesting the importance of potentially long-term chlamydia infection in the progression to trichiasis. Antibiotic distribution programmes for trachoma control should include women with scars.     

Rapid assessment for prioritisation of trachoma control at community level in one district of the Kaolack Region, Senegal

The objective of this study was to use a modified Lot Quality Assurance Sampling methodology to classify communities according to prevalence of active trachoma and to estimate the prevalence of trachoma and trichiasis in Nioro department, Kaolack Region, Senegal. A survey was conducted using two-stage cluster sampling to select 50 children aged 2-5 years in each of 33 clusters. In total 1,648 children were examined for active trachoma. Information on trachoma risk factors was collected through interviews with the mother or the household head of the child. Adults (>40 years) with trichiasis were identified through case finding. Nineteen clusters had a low prevalence of active trachoma in children aged 2-5 years (<20%), 11 had medium prevalence (20-40%) and three had high prevalence (>40%). The prevalence of active trachoma in children aged 2-5 years was 17.4% (95% CI 12.9-21.8%). Multivariate-adjusted predictors of active trachoma were: age, facial cleanliness, hygiene practices and keeping cattle in the household. The prevalence of trichiasis in adults aged over 40 years was 1.77% (95% CI 1.24-2.51), equating to 985 adults (95% CI 765-1250) with trichiasis in Nioro department. In conclusion, a survey using rapid methodology showed that trachoma is a problem of public significance in Nioro department, Senegal.     

Prevalence and control of trachoma in Australia, 1997-2004

This study aimed to document the prevalence of active trachoma and trichiasis from 1997 to 2003 and from 1987 to 2004, respectively, and to provide an overview of trachoma control activities in Australia in 2004. Prevalence data were obtained from state, territory and regional population health units and unpublished surveys. Information about trachoma control programs and activities currently implemented in Australia was obtained through structured interviews with staff involved in trachoma control. Active trachoma prevalence in Aboriginal and Torres Strait Islander children, ranging from 0-40 per cent, were reported from the Eastern Goldfields, Midwest-Murchison and Kimberley Population Health Units in Western Australia and the Northern Territory's Centre for Disease Control. Large differences in trachoma prevalence were reported within and between different regions and from different years in the same region. Recent surveys of trichiasis in Kimberley and Central Australian Aboriginal and Torres Strait Islander adults demonstrated a prevalence of 9-12 per cent in inland, desert areas. In contrast with developing countries where active trachoma and trichiasis are more common among adult women than men, Australian surveys have identified equal prevalence in both sexes. Interpretation of trachoma prevalence and inter-regional/state/national comparisons were hampered by lack of a uniform method of data collection and analysis. Trachoma control programs were implemented consistently in some communities, and irregularly and/or in piecemeal fashion in others. Trachoma control programs led by regional population health units working in collaboration with primary health care services were more likely to be consistently implemented over long periods of time. Trachoma is a significant public health issue in some Aboriginal communities within Australia. The Communicable Diseases Network Australia has developed guidelines for the public health management of trachoma which provide recommendations on trachoma screening, control and data collection trachoma for affected states and territories.     

Risk factors for active trachoma in children and trichiasis in adults: a household survey in Amhara Regional State, Ethiopia

Identification of risk factors is essential for planning and implementing effective trachoma control programmes. We aimed to investigate risk factors for active trachoma and trichiasis in Amhara Regional State, Ethiopia. A survey was undertaken and eligible participants (children aged 1-9 years and adults aged 15 years and above) examined for trachoma. Risk factors were assessed through interviews and observations. Using ordinal logistic regression, associations between signs of active trachoma in children and potential risk factors were explored. Associations between trichiasis in adults and potential risk factors were investigated using conventional logistic regression. A total of 5427 children from 2845 households and 9098 adults from 4039 households were included in the analysis. Ocular discharge [odds ratio (OR)=5.9; 95% CI 4.8-7.2], nasal discharge (OR=1.6; 95% CI 1.3-1.9), thatch roof in household (OR=1.3; 95% CI 1.0-1.5), no electricity in household (OR=2.4; 95% CI 1.3-4.3) and increasing altitude (Ptrend<0.001) were independently associated with severity of active trachoma. Trichiasis was associated with increasing age (ORper 5 year increase=1.5; 95% CI 1.4-1.7), female gender (OR=4.5; 95% CI 3.5-5.8), increasing prevalence of active trachoma in children (Ptrend=0.003) and increasing altitude (Ptrend=0.015).     

The SAFE strategy for the elimination of trachoma by 2020: will it work?

WHO has recently launched a programme (GET 2020) for the elimination of trachoma, the leading cause of preventable blindness. GET 2020 has adopted the SAFE strategy, a comprehensive set of control measures (Surgery for entropion/trichiasis; Antibiotics for infectious trachoma; Facial cleanliness to reduce transmission; Environmental improvements such as control of disease-spreading flies and access to clean water). The present article reviews the strengths and weaknesses of each component of the strategy. Although significant hurdles remain to be overcome there is every reason to hope that GET 2020 will be successful.     

Adolescents’ Beliefs About Forced Sex in KwaZulu-Natal,South Africa

Gender-based violence has serious consequences for the psychological, physical, and sexual well-being of both men and women. Various gender roles, attitudes, and practices in South Africa create an environment that fosters submission and silence in females and hegemony and coercion in males. One of the expressions of this power inequity is a high prevalence of forced sex, which in its turn is associated with higher risk of HIV infection. This study therefore assessed potential gender differences in beliefs about forced sex and in prevalence of reported forced sex among high school students (N = 764) in KwaZulu-Natal. Results showed that significantly more boys were sexually active (26 %) than girls (12 %) and that boys experienced earlier sexual debut by over a year. Boys also held a more positive view about forced sex than girls since they associated it more often with signs of love, as an appropriate way to satisfy sexual urges, and as acceptable if the girl was financially dependent on the boy. The perception that peers and friends considered forced sex to be an effective way to punish a female partner was also more common among boys. On the other hand, boys were less knowledgeable about the health and legal consequences of forced sex, but no significant differences were found for other sociocognitive items, such as self-efficacy and behavioral intention items. Consequently, health education programs are needed to inform both boys and girls about the risks of forced sex, to convince boys and their friends about its inappropriateness and girls to empower themselves to avoid forced sex.     

Evaluation of Community-Based Trichiasis Surgery in Northwest Ethiopia

Background

Surgery to correct trachomatous trichiasis (TT) is recommended to prevent blindness caused by trachoma. This study evaluated the outcomes of community-based trichiasis surgery with absorbable sutures, conductd in Amhara Regional State, Ethiopia.

Methods

A simple random sample of 431 patients was selected from surgical campaign records of which 363 (84.2%) were traced and enrolled into the study. Participants were interviewed and examined for trichiasis recurrence, complications of TT surgery and corneal opacity. Multilevel logistic regression models were used to explore the associations between trichiasis recurrence, corneal opacity and explanatory variables at the eye level.

Results

The prevalence of trichiasis recurrence was 9.4% (95% Confidence Interval [CI] 6.6–12.8) and corneal opacity was found in 14.3% (95% CI 10.9–18.3) of the study participants. The proportion of participants with complications of TT surgery was: granuloma 0.6% (95% CI 0.1–2.0); lid closure defects 5.5% (95% CI 3.4–8.4) and lid notching 16.8% (95% CI 13.1–21.1). No factors were identified for trichiasis recurrence. Corneal opacity was associated with increased age (Ptrend=0.001), more than 12 months post surgery (OR=2.7; 95%CI 1.3–5.6), trichiasis surgery complications (OR=2.9; 95%CI 1.4–5.9) and trichiasis recurrence (OR=2.5; 95%CI 1.0–6.3).

Conclusion

Prevalence of recurrent trichiasis and granuloma were lower than expected but higher for lid closure defects and lid notching. The majority of the participants reported satisfaction with the trichiasis surgery they had undergone. The findings suggest that recurrence of trichiasis impacts on the patients'' risk of developing corneal opacity but longitudinal studies are required to confirm this.     

Risk factors for trachomatous trichiasis in children: cross-sectional household surveys in Southern Sudan

We have previously documented blinding trachoma to be a serious public health problem in Southern Sudan, with an unusually high prevalence of trachomatous trichiasis (TT) among children. We aimed to investigate risk factors for TT in children in Southern Sudan. Cross-sectional surveys were undertaken in 11 districts between 2001 and 2006, and eligible participants were examined for trachoma signs. Risk factors were assessed through interviews and observations. Using logistic regression, associations between TT in children and potential risk factors were investigated. In total, 11155 children aged 1-14 years from 3950 households were included in the analysis. Overall prevalence of TT was 1.5% (95% CI 1.1-2.1). Factors independently associated with increased odds of TT in children aged 1-14 years were: increasing age (P(trend)<0.001); female gender (odds ratio=1.5; 95% CI 1.1-2.1); increasing proportion of children in the household with trachomatous inflammation-intense (TI) (P(trend)=0.002); and increasing number of adults in the household with TT (P(trend)<0.001). Our study revealed risk factors for TT in children consistent with those previously reported for TT in adults. While the associations of TT in children with TI in siblings and TT in adult relatives merit further investigation, there is an urgent need for trachoma prevention interventions and trichiasis surgery services that are tailored to cater for young children in Southern Sudan.     

Women and coronary artery disease: A review of the literature

This article attempts to answer the following questions: Are there differences in the risk factors between women and men? Do the clinical manifestations of CAD differ between the sexes? What is the course of the disease for women? What if any are the rehabilitation factors specific to women? From our literature review it became obvious that there are data gaps that limit our ability to answer the four questions completely. The research we report on mainly has been done prior to 1979 and the major focus was on male response to CAD. This material does not adequately describe an overview of the disease and its effects on the psychosocial and physiological aspects of women.

As health professionals who strive for research based clinical practice, it is strongly indicated that females and CAD should be studied in as great a depth as the male population and CAD.     

Epidemiology of trachoma in Bebedouro State of S?o Paulo, Brazil: prevalence and risk factors.

Trachoma was considered to have been 'eradicated' from the state of S?o Paulo, Brazil, until 1982 when a number of new cases of trachoma were reported in preschool children in Bebedouro, a small town in northwestern S?o Paulo. A household survey was undertaken to assess the prevalence and epidemiological characteristics of trachoma. A total of 2939 people of all ages was examined having been selected from a two-stage probalilistic household sampling frame based on census data. Overall, 7.2% of the population had evidence of one or more signs of trachoma and 2.1% had inflammatory trachoma. Inflammatory trachoma was more common in children aged one to ten years, especially in the peripheral urban and rural areas, and was more common in boys. The presence of chlamydia was confirmed by direct fluorescent antibody cytology. No cases of blindness due to trachoma were seen. A number of socioeconomic and hygiene variables were studied in order to determine the independent risk factors for trachoma in a household. Variables significantly associated with the occurrence of trachoma in the household were the number of children in the house aged one to ten years, the 'per capita' water consumption, the frequency of garbage collections, source of water, and the educational level of the head of household. Clustering of trachoma in different parts of this community was entirely explained by the concentration of households with these characteristics.     

The epidemiology of trachoma in Eastern Equatoria and Upper Nile States, southern Sudan

OBJECTIVE: Limited surveys and anecdotal data indicate that trachoma is endemic in the states of Eastern Equatoria and Upper Nile in southern Sudan. However, its magnitude and geographical distribution are largely unknown. We conducted surveys to ascertain the prevalence and geographical distribution of trachoma, and to identify targets for control interventions. METHODS: Population-based cross-sectional surveys were conducted in nine sites in southern Sudan between September 2001 and June 2004. Two-stage random cluster sampling with probability proportional to size was used to select the sample. Trachoma grading was done using the WHO simplified grading system. FINDINGS: A total of 17 016 persons were examined, a response rate of 86.1% of the enumerated population. Prevalence of signs of active trachoma in children aged 1-9 years was: TF=53.7% (95% confidence interval (CI)=52.1-55.3); TI=42.7% (95% CI=41.2-44.2); TF and/or TI=64.1% (95% CI=62.5-65.5). Prevalence of trichiasis (TT) in children aged less than 15 years was 1.2% (95% CI=0.9-1.4), while TT prevalence in persons aged 15 years and above was 9.2% (95% CI=8.6-9.9). Women were more likely to have trichiasis compared to men (odds ratio (OR)=1.57; 95% CI=1.34-1.84). Tentative extrapolation to the states of Eastern Equatoria and Upper Nile estimates that there is a backlog of 178,250 (lower and upper bounds=156,027-205,995) persons requiring surgery and the entire population, estimated to be over 3.9 million, is in need of the SAFE strategy to control blinding trachoma. CONCLUSION: Trachoma is a public health problem in all nine of the study sites surveyed. The unusually high prevalence of active trachoma and TT in children points to the severity of the problem. There is urgent need to implement trachoma control interventions in trachoma endemic regions of southern Sudan.     

Mapping the global distribution of trachoma

OBJECTIVE: We aimed to summarize and map the existing global population-based data on active trachoma and trichiasis. Detailed distribution maps of various infectious diseases have proved a valuable tool in their control. Such maps play an important role in assessing the magnitude of the problem, defining priority areas for control, monitoring changes, and advocacy. Until now, information on trachoma prevalence at within country levels has not been systematically collated, analysed and reported. METHODS: We gathered the last 18 years' worth of reported data on active trachoma in children aged less than 10 years, and the last 25 years of reported trichiasis in adults aged 15 years and over from 139 population-based surveys in 33 countries. We collated these data into one database using the "district" (second administrative level) as the standard unit of reporting. We used Geographical Information Systems as a database and cartographic tool to generate a global map of the prevalence of trachoma and trichiasis. FINDINGS: We obtained data on active trachoma and trichiasis from 18 countries in the WHO African Region, 6 in the Eastern Mediterranean Region, 3 in the South-East Asia Region, 3 in the Western Pacific Region and 2 in the Region of the Americas. In 23 countries suspected of having endemic trachoma no reliable district-level population-based data were available. In China and India, data were limited to a few districts. The data highlighted important regional differences and marked national variations in prevalence of active trachoma and trichiasis. CONCLUSION: This is the first attempt to summarize and map the existing population-based data on active trachoma and trichiasis. The lack of data in many countries remains an important obstacle to trachoma control efforts.     

Gender differences in health: a Canadian study of the psychosocial, structural and behavioural determinants of health

Gender-based inequalities in health have been frequently documented. This paper examines the extent to which these inequalities reflect the different social experiences and conditions of men's and women's lives. We address four specific questions. Are there gender differences in mental and physical health? What is the relative importance of the structural, behavioural and psychosocial determinants of health? Are the gender differences in health attributable to the differing structural (socio-economic, age, social support, family arrangement) context in which women and men live, and to their differential exposure to lifestyle (smoking, drinking, exercise, diet) and psychosocial (critical life events, stress, psychological resources) factors? Are gender differences in health also attributable to gender differences in vulnerability to these structural, behavioural and psychosocial determinants of health? Multivariate analyses of Canadian National Population Health Survey data show gender differences in health (measured by self-rated health, functional health, chronic illness and distress). Social structural and psychosocial determinants of health are generally more important for women and behavioural determinants are generally more important for men. Gender differences in exposure to these forces contribute to inequalities in health between men and women, however, statistically significant inequalities remain after controlling for exposure. Gender-based health inequalities are further explained by differential vulnerabilities to social forces between men and women. Our findings suggest the value of models that include a wide range of health and health-determinant variables, and affirm the importance of looking more closely at gender differences in health.     

Long-term health consequences of delayed childbirth: NHANES III.

Medicine has pointed to short-term, immediate health risks to child and mother of delaying childbearing past the age of 35 years. The long-term health consequences of delayed childbearing have not been the subject of research. Are women who delay having children to pursue education and career goals placing their later health status at risk? To address this question, the study utilizes data from the National Health and Nutrition Examination Survey III 1988-1994. The analyses used odds ratios obtained from stepwise logistic regression analysis to assess women's health risks. The results are suggestive of selective risk enhancement from delayed childbirth with regard to cardiovascular disease and risk factors, especially diabetes and hypertension, and congestive heart failure. Risks were further enhanced in terms of dental health, blood abnormalities, physical mobility, and vision difficulties. Whereas delaying childbearing may indicate a readiness on the part of women and men to delay becoming parents, the present study suggests that not all is currently known about the long-term health consequences of such decisions to delay childbearing.     

Trachoma: still a major cause of blindness

Despite the advent of effective antichlamydial antibiotics and the ability to culture Chlamydia trachomatis (which led to hopes for a vaccine against trachoma), trachoma and its blinding sequelae continue to compromise the health of millions of people worldwide. The cycle of repeated chlamydial reinfections and secondary bacterial conjunctivitis, which leads to conjunctival scarring, lid shortening, trichiasis, entropion, and corneal opacification (causing blindness), can be broken with regular face washing. However, those most at risk live in rural areas where water is scarce and eye clinics inaccessible. The only effective interventions, therefore, seem to be instituting face washing in primary schools, improving personal hygiene through health education, and performing lid surgery in affected communities. Tarsal edge rotation surgery can be carried out in villages in primary schools. Even in areas where lid surgery has been available for a long time, the shortage of trained personnel results in many untreated cases. A teaching videotape is available for this simple procedure. In performing this surgery, it is important to have good local anesthesia, to achieve full and free mobilization of the tarsal strip with appropriate incisions, to separate the obicularis muscle from the tarsal plate, and to place a minimum of 5 horizontal mattress sutures.     

Female Genital Mutilation/Cutting in the United States: Updated Estimates of Women and Girls at Risk, 2012

Objectives

In 1996, the U.S. Congress passed legislation making female genital mutilation/cutting (FGM/C) illegal in the United States. CDC published the first estimates of the number of women and girls at risk for FGM/C in 1997. Since 2012, various constituencies have again raised concerns about the practice in the United States. We updated an earlier estimate of the number of women and girls in the United States who were at risk for FGM/C or its consequences.

Methods

We estimated the number of women and girls who were at risk for undergoing FGM/C or its consequences in 2012 by applying country-specific prevalence of FGM/C to the estimated number of women and girls living in the United States who were born in that country or who lived with a parent born in that country.

Results

Approximately 513,000 women and girls in the United States were at risk for FGM/C or its consequences in 2012, which was more than three times higher than the earlier estimate, based on 1990 data. The increase in the number of women and girls younger than 18 years of age at risk for FGM/C was more than four times that of previous estimates.

Conclusion

The estimated increase was wholly a result of rapid growth in the number of immigrants from FGM/C-practicing countries living in the United States and not from increases in FGM/C prevalence in those countries. Scientifically valid information regarding whether women or their daughters have actually undergone FGM/C and related information that can contribute to efforts to prevent the practice in the United States and provide needed health services to women who have undergone FGM/C are needed.In 1997, Public Health Reports published the first U.S. estimates of the number of women and girls in the United States in 1990 (hereafter referred to as the 1990 estimates) who were at risk for female genital mutilation/cutting (FGM/C).¹ That study was conducted at the request of the U.S. Congress, which passed legislation making FGM/C illegal in the United States. Since 2012, various constituencies have again raised concerns about the practice of FGM/C in the United States.^2–6 New estimates are needed because of substantial growth in the immigrant population of the United States in recent decades and the need to support additional policies to reduce the occurrence of FGM/C.We updated the 1990 estimates of the number of women and girls in the United States who were at risk for FGM/C. We report only the number of women and girls at risk for FGM/C and do not estimate the number of women and girls who have actually undergone the procedure.