Abstract
ABSTRACTPurpose: Trachoma is to be eliminated as a public health problem by 2020. To help the process of planning interventions where needed, and to provide a baseline for later comparison, we set out to complete the map of trachoma in Afar, Ethiopia, by estimating trachoma prevalence in evaluation units (EUs) of grouped districts (“woredas”).Methods: We conducted seven community-based surveys from August to October 2013, using standardised Global Trachoma Mapping Project (GTMP) survey methodologies.Results: We enumerated 5065 households and 18,177 individuals in seven EUs covering 19 of Afar’s 29 woredas; the other ten were not accessible. 16,905 individuals (93.0%) were examined, of whom 9410 (55.7%) were female. One EU incorporating four woredas (Telalak, Dalefage, Dewe, Hadele Ele) was shown to require full implementation of the SAFE strategy for three years before impact survey, with a trachomatous inflammation-follicular (TF) prevalence in 1–9-year-olds of 17.1% (95%CI 9.4–25.5), and a trichiasis prevalence in adults aged ≥15 years of 1.2% (95%CI 0.6–2.0). Five EUs, covering 13 woredas (Berahle, Aba’ala, Dupti, Kurri, Elidihare, Ayesayeta, Afamboo, Bure Mudaitu, Gewane, Amibara, Dulecho, Dalolo, and Konebo), had TF prevalences in children of 5–9.9% and need one round of azithromycin mass treatment and implementation of the F and E components of SAFE before re-survey; three of these EUs had trichiasis prevalences in adults ≥0.2%. The final EU (Mile, Ada’ar) had a sub-threshold TF prevalence and a trichiasis prevalence in adults just >0.2%.Conclusion: Trachoma is a public health problem in Afar, and implementation of the SAFE strategy is required.
Highlights
Trachoma is the world’s leading infectious cause of blindness
A total of 18,177 people were enumerated over 7 evaluation units (EUs) covering 19 woredas. 5065 households were visited in a total of 178 clusters from 13th August, 2013 to 6th
When compared to EUs in several other regions of Ethiopia involved in the GTMP12–14, or Amhara Region[15], the prevalences of trachoma in Afar EUs were low, though the relatively low prevalences are matched in data from northern Ethiopian Somali Region[16], to which Afar is adjacent
Summary
An estimated 3.2 million people are thought to have trichiasis, the potentially blinding stage of the disease.[1] Trachoma limits access to education and prevents individuals from being able to work or care for themselves or their families, and can destroy the economic well-being of entire communities, keeping families shackled within a cycle of poverty as the disease and its long-term effects pass from one generation to the next. The Afar Region in the North-East of Ethiopia has a population of 1.7 million people, with the lowest population density of any region in Ethiopia.[3] The region is one of extremes, playing host to the hottest inhabited place on earth, the Danakil Depression, where daytime temperatures reach up to 54°C, along with the active volcano Erta
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