Burden Of Trachoma Research Articles

Longitudinal Analysis of Eye Health Disparities Due to Trachoma Using Country-Level Data from the Global Burden of Disease Study 2019

ABSTRACT Purpose To assess the change in eye health disparities due to trachoma using longitudinal country-level data (1990–2019) from the global burden of disease study 2019. Methods:Statement We obtained data on the burden of trachoma and population statistics from the Global Health Data Exchange website. We assessed the geographic distribution of trachoma at the global level and World Bank regional level from year to year using Gini coefficients and statistics of inequality that ranged from 0 (total equality) to 1 (total inequality). Result We found that 60 countries and territories had a burden of trachoma, and these were from all regions except Central Europe, Eastern Europe, and Central Asia. At the global level, the Gini coefficient had increased from 0.546 to 0.637 (p for trend: <0.001) in the last three decades, while the mean disability-adjusted life years (DALYs) per 100,000 people declined from 13.0 to 3.2 (p for trend: <0.001). The inequality statistics had significantly worsened in South Asia and Sub-Saharan Africa (p for trend: <0.001) despite the decrease in the mean DALYs per capita. Conclusion Our study revealed that the burden of trachoma dramatically decreased; however, the eye health inequality due to trachoma increased globally and in two of the most endemic regions in the last three decades. Global eye health experts need to monitor the distribution of eye diseases and ensure appropriate, effective, uniform, and high-quality eye care for all.

Perceptions and practices of community members relating to trachoma in Africa: a qualitative systematic review.

The objective of this review was to synthesize the perceptions and practices of community members relating to trachoma in Africa. Trachoma is the leading cause of blindness worldwide, and Africa is the worst-affected continent. Synthesized evidence relating to the disease has focused on various aspects including epidemiology, control, health education, facial cleanliness, interventions for trachomatous trichiasis, and the burden of trachoma on women. Currently, systematic reviews on perceptions and practices relating to trachoma are lacking despite the existence of primary studies. Filling this knowledge gap is critical for decision-making for effective community uptake of interventions. Qualitative studies on the perceptions and practices relating to trachoma in both health care and community settings in Africa were considered for inclusion. Studies with participants 14 years or older were considered, regardless of gender, health status, religion, or ethnicity. Perceptions included beliefs, perspectives, views, knowledge, and thoughts relating to trachoma. Practices included regular actions relating to trachoma, such as treatment and prevention behaviors. A search for studies in English was conducted in MEDLINE, CINAHL, Embase, PsycINFO, Sociological Abstracts, BioMed Central, Current Contents, Cochrane Library, and Google Scholar in May 2019 and updated in October 2021. Unpublished studies were searched in MedNar, Index to Thesis, ProQuest Dissertations and Theses Global, World Health Organization, and individual governments' commissioned trachoma reports. Two independent reviewers were involved in study selection, critical appraisal, and data extraction using the JBI tools. Data were synthesized using the JBI meta-aggregative approach. Seven studies were included in this review. Participants were people either with or without trachoma. A total of 90 findings were extracted, from which 10 categories were produced and three synthesized findings derived from the categories. The synthesized findings are: understanding and awareness of trachoma influences perceptions of treatment and preventive methods; beliefs and behaviors influence treatment options; economic constraints, socio-cultural beliefs, and risk perceptions influence prevention behaviors and practices. Various perceptions and practices relating to trachoma exist among community members in Africa. These perceptions and practices are influenced by knowledge, cultural beliefs, economic factors, and environmental factors. The findings suggest the need for decision-makers in policy and practice to consider and include these perceptions and practices when designing interventions to combat trachoma in endemic countries. However, due to the limited number of included studies and their methodological weaknesses, more high-quality studies are needed to have a deeper and broader view on these perceptions and practices.

Progress Towards Elimination of Trachoma as a Public Health Problem in Eritrea: Results of a Systematic Review and Nine Population-based Prevalence Surveys Conducted in 2014

ABSTRACTPurpose: To assess Eritrea’s progress towards elimination of trachoma as a public health problem, we reviewed and compiled current knowledge on the distribution and burden of trachoma in Eritrea, then undertook further population-based surveys where indicated, with support from the Global Trachoma Mapping Project (GTMP).Methods: For the systematic review, undertaken in March 2014, we searched (1) PubMed, using the terms ((blind* or trachoma or trichiasis) AND Eritrea); (2) the online database of rapid assessments of avoidable blindness; (3) our own grey literature collections; and (4) the Global Atlas of Trachoma database. In June and July 2014, we conducted nine population-based prevalence surveys, for each of which 30 villages were systematically selected with probability proportional to population size; in each village, 30 households were systematically selected. All consenting residents of selected households aged ≥1 year were examined by GTMP-certified graders for signs of trachoma. Data on household-level access to water and sanitation were also collected.Results: One previous rapid assessment of avoidable blindness, three peer-reviewed publications, and two grey literature reports detailing sets of trachoma prevalence surveys conducted in 2006 and 2011, respectively, were located. Post-intervention impact surveys were needed in seven evaluation units (EUs, framed at sub-Zoba-level: population range 40,000–120,000) of Debub and Northern Red Sea, while baseline surveys were needed in two EUs of Anseba. Four of the seven impact survey EUs and both baseline survey EUs returned trachomatous inflammation—follicular prevalences in 1–9-year-olds of ≥5%; six of the seven impact survey EUs and one of the two baseline survey EUs returned trichiasis prevalences in ≥15-year-olds of ≥0.2%. The prevalence of access to water and sanitation varied widely between EUs.Conclusion: Interventions are still required in Eritrea to eliminate trachoma as a public health problem. Data from these surveys will guide the Ministry of Health to undertake programme planning using a sound evidence base.

Burden of trachoma in five counties of Eastern Equatoria state, South Sudan: Results from population-based surveys.

BackgroundIn order to decrease the prevalence of trachoma within the country, the Republic of South Sudan has implemented components of the SAFE strategy in various counties since 2001. Five counties in Eastern Equatoria state were surveyed in order to monitor progress of programmatic interventions and determine if additional rounds of Mass Drug Administration with azithromycin were needed.Methodology/ Principal findingsFive counties (Budi, Lafon, Kapoeta East, Kapoeta South and Kapoeta North) were surveyed from April to October 2015. A cross-sectional, multi-stage, cluster-random sampling was used. All present, consenting residents of selected households were examined for all clinical signs of trachoma using the World Health Organization (WHO) simplified grading system. 14,462 individuals from 3,446 households were surveyed. The prevalence of trachomatous inflammation-follicular (TF) in children ages one to nine years ranged from 17.4% (95% Confidence Interval (CI): 11.4%, 25.6%) in Budi county to 47.6%, (95% CI: 42.3%, 53.0%) in Kapoeta East county. Trachomatous trichiasis (TT) was also highly prevalent in those 15 years and older, ranging between 2.6% (95% CI: 1.6%, 4.0%) in Kapoeta South to 3.9% (95% CI: 2.4%, 6.1%) in Lafon. The presence of water and sanitation were low in all five counties, including two counties which had a complete absence of latrines in all surveyed clusters.Conclusions/ SignificanceTo our knowledge, these were the first trachoma surveys conducted in the Republic of South Sudan since their independence in 2011. The results show that despite years of interventions, four of the five surveyed counties require a minimum of five additional years of SAFE strategy implementation, with the fifth requiring at minimum three more years.

Spreading the word: Preventing trachoma through advocacy

Trachoma is a painful eye condition that is caused by Chlamydia Trachomatis. If left untreated, repeated infections cause the eyelid to turn inwards. This condition is known as trachomatous trichiasis, or blinding trachoma, and results in intense pain and scarring on the front of the eye that ultimately leads to blindness. To address the huge burden of trachoma in Ethiopia, CBM has collaborated with the Organization for Rehabilitation and Development in Amhara to implement the Amhara Trachoma Control Program (ATCP) since 2006. In this article, Degu Hassen provides a personal account of his experiences as a trachoma patient and describes how attending a community awareness session led to his decision to undergo surgery.

Correction: The Geographical Distribution and Burden of Trachoma in Africa

In Table 3 the entry for Ethiopia contains incorrect sums of the subpopulation data within the larger geographical zones. Please see the corrected Table 3 here:

The Geographical Distribution and Burden of Trachoma in Africa

BackgroundThere remains a lack of epidemiological data on the geographical distribution of trachoma to support global mapping and scale up of interventions for the elimination of trachoma. The Global Atlas of Trachoma (GAT) was launched in 2011 to address these needs and provide standardised, updated and accessible maps. This paper uses data included in the GAT to describe the geographical distribution and burden of trachoma in Africa.MethodsData assembly used structured searches of published and unpublished literature to identify cross-sectional epidemiological data on the burden of trachoma since 1980. Survey data were abstracted into a standardised database and mapped using geographical information systems (GIS) software. The characteristics of all surveys were summarized by country according to data source, time period, and survey methodology. Estimates of the current population at risk were calculated for each country and stratified by endemicity class.ResultsAt the time of writing, 1342 records are included in the database representing surveys conducted between 1985 and 2012. These data were provided by direct contact with national control programmes and academic researchers (67%), peer-reviewed publications (17%) and unpublished reports or theses (16%). Prevalence data on active trachoma are available in 29 of the 33 countries in Africa classified as endemic for trachoma, and 1095 (20.6%) districts have representative data collected through population-based prevalence surveys. The highest prevalence of active trachoma and trichiasis remains in the Sahel area of West Africa and Savannah areas of East and Central Africa and an estimated 129.4 million people live in areas of Africa confirmed to be trachoma endemic.ConclusionThe Global Atlas of Trachoma provides the most contemporary and comprehensive summary of the burden of trachoma within Africa. The GAT highlights where future mapping is required and provides an important planning tool for scale-up and surveillance of trachoma control.

An Interfaith Dialogue on the Neglected Tropical Diseases

An Interfaith Dialogue on the Neglected Tropical Diseases

Tracoma en América Latina: una oportunidad para su eliminación

Trachoma is still the leading infectious cause of blindness world-wide (1). Caused by Chlamydia trachomatis, this chronic conjunctivitis is part of a host of Neglected Tropical Diseases that plague resource-poor communities world wide. The World Health Assembly passed a resolution calling for the Elimination of Blinding Trachoma by the year 2020 (2), and the Pan American Health Organization has recently endorsed this resolution specifically for trachoma in the Americas.How big is the burden of trachoma in the Americas? Clearly, at one time trachoma was a public health problem all through the Americas; at one time 80% of the United States Public Health Service budget was devoted to screening for this disease. However, trachoma declined as the socioeconomic status of all countries improved, and eventually was forgotten by the public health authorities, except those working in the more marginalized populations. Now, there is an opportunity with the renewed emphasis on Neglected Tropical Diseases and the push towards declaring trachoma elimination to identify the pockets of trachoma and undertake strategies for control once and for all.Hotez and colleagues have estimated about 1.1 million persons currently have trachoma in Latin America in three countries, accounting for 1.3% of the Global Disease Burden in Latin America (3). Brazil, Guatemala, and Mexico were cited as still endemic, based on reports from 2003. However, the identification of endemic areas is far from complete, and the finding of trachoma in indigenous populations in Brazil can only mean that other populations that roam throughout the Amazonian basin may also be affected (4). We know that trachoma is a significant problem when found in nomadic persons, as the programs for control must be implemented across country boundaries; this is well illustrated by the lack of control of trachoma in the Maasai populations of Tanzania and Kenya, who move freely between the two countries.The article by Miller, Gallego and Rodriguez in this issue (5) then is very important in raising awareness that trachoma is present in the Colombian region of Vaupes. The authors conducted this study under extreme circumstances, and are to be congratulated for their efforts. The images that accompany the article leave no doubt that trachoma certainly was a problem in the past, as indicated by the trichiasis cases found in these communities. The current extent of the problem of active trachoma is less clear. Clinical diagnosis of active, follicular trachoma can be confusing when the disease has low prevalence as it must be differentiated from other causes of follicular conjunctivitis, such as vernal conjunctivitis. While the image of trachomatous inflammation - follicular (TF) is certainly compelling, confirmation of cases using modern diagnostic tests for C. trachomatis would have been very helpful. Nevertheless, the finding of cases in this vulnerable population cannot be ignored and sounds an alarm that further action is required to plan a strategy.The authors have reported on the SAFE strategy recommended by the World Health Organization for trachoma control: Surgery to correct trichiasis, antibiotic to control infection, and face washing and environmental improvements to reduce transmission. Also, they have concluded that further confirmatory surveys be conducted. We agree with a phased-in approach to planning for trachoma control at this stage, and would suggest the following as a result of this study:1. A plan to offer surgical services to correct the imminent risk of blindness posed by trichiasis needs to be devised by local health authorities. Cases will not come on their own without knowledge of affordable quality services they can access. Indigenous health workers and/or the health promoters should be taught to find cases of trichiasis and make sure they are brought to the nearest facility for trichiasis surgery, and that trained and certified surgeons can operate on them at low or no cost.2. The burden of active trachoma in this region needs to be determined, using cluster survey methods that will estimate the prevalence in 0-9 year old children as recommended by WHO. The cases should be confirmed using a diagnostic test to leave no doubt as to their origin. More experience with such methods is being developed in Latin America for NTD work, and could easily be applied to trachoma mapping.3. As a result of the findings of the mapping, an approach to trachoma control needs to be devised by Colombia. Ideally, this would include coordination of activities with Brazil and Peru in an unprecedented multi-national collaboration to eliminate a blinding disease.There is strong commitment by partners in WHO, PAHO, and non-governmental organizations to have the Americas be the first region to report elimination of trachoma. Studies such as these are crucial to the start of raising awareness, and starting efforts to address how trachoma control will be accomplished so as to achieve the goal of elimination by 2020.

The Burden of Trachoma in Ayod County of Southern Sudan

BackgroundBlindness due to trachoma is avoidable through Surgery, Antibiotics, Facial hygiene and Environmental improvements (SAFE). Recent surveys have shown trachoma to be a serious cause of blindness in Southern Sudan. We conducted this survey in Ayod County of Jonglei State to estimate the need for intervention activities to eliminate blinding trachoma.Methodology and FindingsA cross-sectional two-stage cluster random survey was conducted in November 2006. All residents of selected households were clinically assessed for trachoma using the World Health Organization (WHO) simplified grading scheme. A total of 2,335 people from 392 households were examined, of whom 1,107 were over 14 years of age. Prevalence of signs of active trachoma in children 1–9 years of age was: trachomatous inflammation follicular (TF) = 80.1% (95% confidence interval [CI], 73.9–86.3); trachomatous inflammation intense (TI) = 60.7% (95% CI, 54.6–66.8); and TF and/or TI (active trachoma) = 88.3% (95% CI, 83.7–92.9). Prevalence of trachomatous trichiasis (TT) was 14.6% (95% CI, 10.9–18.3) in adults over 14 years of age; 2.9% (95% CI, 0.4–5.3) in children 1–14 years of age; and 8.4% (95% CI, 5.5–11.3) overall. The prevalence of corneal opacity in persons over 14 years of age with TT was 6.4% (95% CI, 4.5–8.3). No statistically significant difference was observed in the prevalence of trachoma signs between genders. Trachoma affected almost all households surveyed: 384/392 (98.0%) had at least one person with active trachoma and 130 (33.2%) had at least one person with trichiasis.ConclusionsTrachoma is an unnecessary public health problem in Ayod. The high prevalence of active trachoma and trichiasis confirms the severe burden of blinding trachoma found in other post-conflict areas of Southern Sudan. Based on WHO recommended thresholds, all aspects of the SAFE strategy are indicated to eliminate blinding trachoma in Ayod.

Barriers to Acceptance of Intervention among Patients with Trachomatous Trichiasis or Entropion Presenting to a Teaching Hospital

Purpose: To determine the barriers to therapeutic intervention in patients with trachomatous trichiasis or entropion. Methods: Prospective study over one year in 60 patients with trachomatous trichiasis or entropion presenting to a teaching hospital. The outcome measure was reported barriers to uptake of intervention using a questionnaire. The data were analysed using chi-square and Fisher's exact tests. Patient characteristics were correlated with barriers using univariate and multivariate analysis. Results: The major barriers (operative in > 60% of patients) were illiteracy (66.7%), ignorance regarding treatment (65.0%), and fear of surgery (63.3%). Duration of symptoms in 43 females and 17 males ranged from 0.5 to 240 months (mean 30.2 ± 45.82). Females reported significantly more barriers (average 5.8 ± 1.88) than males (average 4.6 ± 1.97; p = 0.03). Shorter duration was significantly related to perceived expense (p = 0.008). Patients aged ≤55 years more often cited young children as a barrier (p = 0.02). Conclusions: Encouraging patients who have undergone intervention to share their experiences with community members, providing intervention in patients' villages, community involvement with patients who live alone and making gender-sensitive medical programmes might be useful in reducing the fear of surgery and enhancing awareness and uptake of intervention. Future studies must identify barriers in their regions so that attempts can be directed to overcoming them so as to reduce the blinding and non-blinding burden of trachoma.

Health-Related Quality of Life in Patients with Trachomatous Trichiasis or Entropion

Purpose: To determine the health-related quality of life in patients with trachomatous trichiasis or entropion, before and after intervention. Methods: A prospective, case-control, interventional study. Health-related quality of life was evaluated in 60 patients with trachomatous trichiasis or entropion, before and after intervention, and 60 age- and gender-matched controls without trichiasis or entropion, using the WHOQOL-Bref questionnaire. Thirty patients and controls had vision < 6/18, while 30 had vision ≥ 6/18 in the better eye. The WHOQOL-Bref assesses four domains of quality of life: physical health (1), psychological health (2), social relationships (3), and environment (4). Domain scores of patients and controls and of patients before and after intervention were compared using Student's t-test. Patient characteristics were correlated with domain scores using Pearson's correlation. Results: Quality of life was poorer than that of controls in domains 1 and 2 for patients with vision < 6/18 in the better eye (p < 0.001, p = 0.001, respectively), and in domains 1, 2 and 4 for patients with vision ≥ 6/18 (p < 0.001, p < 0.001, p = 0.01, respectively). Scores improved after intervention in all domains except domain 3, even though vision did not improve. Conclusions: Patients with trachomatous trichiasis or entropion suffer in the physical, psychological and environmental domains of health-related quality of life even when vision is normal. Timely intervention is essential not only to prevent corneal blindness but also to reduce the suffering caused by the non-visual symptoms. Future studies must identify barriers to therapeutic intervention, and attempts should be directed at overcoming them so as to reduce the non-blinding burden of trachoma.