Abstract
ABSTRACTPurpose: Previous phases of trachoma mapping in Pakistan completed baseline surveys in 38 districts. To help guide national trachoma elimination planning, we set out to estimate trachoma prevalence in 43 suspected-endemic evaluation units (EUs) of 15 further districts.Methods: We planned a population-based trachoma prevalence survey in each EU. Two-stage cluster sampling was employed, using the systems and approaches of the Global Trachoma Mapping Project. In each EU, residents aged ≥1 year living in 30 households in each of 26 villages were invited to be examined by trained, certified trachoma graders. Questionnaires and direct observation were used to evaluate household-level access to water and sanitation.Results: One EU was not completed due to insecurity. Of the remaining 42, three EUs had trichiasis prevalence estimates in ≥15-year-olds ≥0.2%, and six (different) EUs had prevalence estimates of trachomatous inflammation—follicular (TF) in 1–9-year-olds ≥5%; each EU requires trichiasis and TF prevalence estimates below these thresholds to achieve elimination of trachoma as a public health problem. All six EUs with TF prevalences ≥5% were in Khyber Pakhtunkhwa Province. Household-level access to improved sanitation ranged by EU from 6% to 100%. Household-level access to an improved source of water for face and hand washing ranged by EU from 37% to 100%.Conclusion: Trachoma was a public health problem in 21% (9/42) of the EUs. Because the current outbreak of extremely drug-resistant typhoid in Pakistan limits domestic use of azithromycin mass drug administration, other interventions against active trachoma should be considered here.
Highlights
Trachoma is a neglected tropical disease[1] and the leading infectious cause of blindness worldwide.[2]
In 23 (55%) of the evaluation units (EUs), ≥80% of households had access to improved sanitation (Table 3). Data from this fourth phase of baseline mapping represent another important step towards complete categorization of the distribution and burden of trachoma in Pakistan
Three of 42 EUs mapped were shown to qualify for public-health-level deployment of trichiasis surgical services, and only six EUs were shown to qualify for intervention with A, F, and E components of SAFE.[36]
Summary
Trachoma is a neglected tropical disease[1] and the leading infectious cause of blindness worldwide.[2] Trachomatous inflammation— follicular (TF) and/or trachomatous inflammation—intense (TI) are signs of active trachoma that can occur when certain strains[3,4] of the bacterium Chlamydia trachomatis infect the conjunctivae. Trichiasis is a complication of trachoma that occurs after multiple episodes of infection and associated inflammation,[5] typically in adulthood.[6,7,8] It is characterized by in-turned eyelashes touching the eyeball, which may lead to pain, corneal ulceration, corneal scarring, and visual impairment.[9,10,11]. World Health Organization (WHO) recommends implementation of the SAFE strategy: Surgery to redirect inturned eyelashes away from the eye; Antibiotics to clear infection; and Facial cleanliness and Environmental improvement to reduce transmission.[13,14] In order to
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