Progress to Eliminate Trachoma as a Public Health Problem in Amhara National Regional State, Ethiopia: Results of 152 Population-Based Surveys.

Aisha E P Stewart,Paul M Emerson,Mulat Zerihun,Tekola Endeshaw,Tigist Astale,Jonathan D King,Scott D Nash,Tesfaye Teferi,Eshetu Sata,Birhan Gaudie,Andrew W Nute,Demelash Gessese,Elizabeth Kelly Callahan,Berhanu Melak,Melsew Chanyalew,Zerihun Tadesse

doi:10.4269/ajtmh.19-0450

Abstract

.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 ≥ 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.

Highlights

National trachoma programs conduct impact and surveillance surveys to assess the prevalence of clinical signs of trachoma and progress toward elimination as a public health problem
The targets for elimination as a public health problem include a prevalence of trachomatous inflammation-follicular (TF) among children aged [1,2,3,4,5,6,7,8,9] years of less than 5% at the health district level and a prevalence of trachomatous trichiasis (TT) unknown to the health system among the total population of less than one case per 1,000 at the health district level.[1]
Survey teams recorded the time taken to walk from the vehicle to the cluster: 53.9% required less than a 1-hour walk, 25.8% required a 1- to 3-hour walk, and 20.4% required greater than a 3-hour walk

Summary

Introduction

National trachoma programs conduct impact and surveillance surveys to assess the prevalence of clinical signs of trachoma and progress toward elimination as a public health problem. The targets for elimination as a public health problem include a prevalence of trachomatous inflammation-follicular (TF) among children aged [1,2,3,4,5,6,7,8,9] years of less than 5% at the health district level and a prevalence of trachomatous trichiasis (TT) unknown to the health system among the total population of less than one case per 1,000 at the health district level.[1] Trachoma impact surveys (TIS) are presently conducted following [1,2,3,4,5,6,7] years of implementation of the WHO-endorsed surgery, antibiotics, facial cleanliness, and environmental improvement (SAFE) strategy[2]; previous guidance, followed until roughly 2017, called for TIS following [3,4,5] years of SAFE implementation.[3]. Following the 2006 National Survey, further baseline data were collected during a 2007 zonal-level survey, which provided needed evidence to determine the zones (administrative unit below a region with about 2,000,000 population and made up of districts) that warranted SAFE intervention

Methods

Results

Conclusion