WHO Simplified Grading System Research Articles

Prevalence and associated factors of active trachoma among 1\u20139\u2009years old children in Deguatemben, Tigray, Ethiopia, 2018: community cross-sectional study

BackgroundTrachoma is a contagious infection of the eye. World Health Organization recommended three rounds of mass drug administration in districts where the prevalence of trachomatous follicular (TF) is ≥10% in children aged 1–9 years. Mass drug distribution was given to residents for three consecutive years with more than 90% coverage. However, the prevalence and associated factors of active trachoma in the study community after the intervention was not yet determined. Thus, this deals with the prevalence and associated factors of active trachoma among children aged 1–9 years.MethodsWe conducted a Community based cross-sectional study among 502 children aged 1–9 in March 2018 in Deguatemben. A multi-stage sampling technique was applied. Selected children were examined for trachoma using 2.5x binocular loupe and graded based on the WHO simplified grading system. Mothers were interviewed for factors associated with trachoma using a structured questionnaire. Data was entered on Epi-Info and exported to SPSS for analysis. Both descriptive and inferential analyses were done with 95% confidence intervals (CIs) at a p-value < 0.05 for the final model.ResultsThe prevalence of active trachoma was found 21.5% (95% CI: 17.8–25.1%). Being 1 to 4 years old [AOR (95% CI) = 6.81(2.00–23.11)], not washing face [AOR (95% CI) =9.31(1.13–77.66)], not using soap [AOR (95% CI) =5.84(1.87–18.21)], unclean face [AOR(95% CI) = 18.22(4.93–69.32)] and mother’s knowledge [AOR (95% CI) =0.06(0.02–0.19)] were found as independent predictors.ConclusionThe prevalence declined from the baseline, but it is still a public health problem in the district. Personal-related factors were found to be associated with the disease. Health education of “Facial cleanness” and related factors is recommended to increase knowledge of the mothers on their children’s care in addition to the provision of antibiotics.

Serological and PCR-based markers of ocular Chlamydia trachomatis transmission in northern Ghana after elimination of trachoma as a public health problem.

BackgroundValidation of elimination of trachoma as a public health problem is based on clinical indicators, using the WHO simplified grading system. Chlamydia trachomatis (Ct) infection and anti-Ct antibody responses (anti-Pgp3) have both been evaluated as alternative indicators in settings with varying levels of trachoma. There is a need to evaluate the feasibility of using tests for Ct infection and anti-Pgp3 antibodies at scale in a trachoma-endemic country and to establish the added value of the data generated for understanding transmission dynamics in the peri-elimination setting.Methodology/Principal findingsDried blood spots for serological testing and ocular swabs for Ct infection testing (taken from children aged 1–9 years) were integrated into the pre-validation trachoma surveys conducted in the Northern and Upper West regions of Ghana in 2015 and 2016. Ct infection was detected using the GeneXpert PCR platform and the presence of anti-Pgp3 antibodies was detected using both the ELISA assay and multiplex bead array (MBA). The overall mean cluster-summarised TF prevalence (the clinical indicator) was 0.8% (95% CI: 0.6–1.0) and Ct infection prevalence was 0.04% (95%CI: 0.00–0.12). Anti-Pgp3 seroprevalence using the ELISA was 5.5% (95% CI: 4.8–6.3) compared to 4.3% (95%CI: 3.7–4.9) using the MBA. There was strong evidence from both assays that seropositivity increased with age (p<0.001), although the seroconversion rate was estimated to be very low (between 1.2 to 1.3 yearly events per 100 children).Conclusions/SignificanceInfection and serological data provide useful information to aid in understanding Ct transmission dynamics. Elimination of trachoma as a public health problem does not equate to the absence of ocular Ct infection nor cessation in acquisition of anti-Ct antibodies.

Elimination of trachoma as a public health problem in Ghana: Providing evidence through a pre-validation survey.

BackgroundIn order to achieve elimination of trachoma, a country needs to demonstrate that the elimination prevalence thresholds have been achieved and then sustained for at least a two-year period. Ghana achieved the thresholds in 2008, and since 2011 has been implementing its trachoma surveillance strategy, which includes community and school screening for signs of follicular trachoma and trichiasis, in trachoma-endemic districts. In 2015–2016, the country conducted a district level population-based survey to validate elimination of trachoma as a public health problem.MethodsAs per WHO recommendations, a cross-sectional survey, employing a two-stage cluster random sampling methodology, was used across 18 previously trachoma endemic districts (evaluation units (EUs) in the Upper West and Northern Regions of Ghana. In each EU 24 villages were selected based on probability proportional to estimated size. A minimum of 40 households were targeted per village and all eligible residents were examined for clinical signs of trachoma, using the WHO simplified grading system. The number of trichiasis cases unknown to the health system was determined. Household environmental risk factors for trachoma were also assessed.ResultsData from 45,660 individuals were examined from 11,099 households across 18 EUs, with 27,398 (60.0%) children aged 1–9 years and 16,610 (36.4%) individuals 15 years and above All EUs had shown to have maintained the WHO elimination threshold for Trachomatous inflammation-Follicular (TF) (<5.0% prevalence) in children aged 1–9 years old. The EU TF prevalence in children aged 1–9 years old ranged from between 0.09% to 1.20%. Only one EU (Yendi 0.36%; 95% CI: 0.0–1.01) failed to meet the WHO TT elimination threshold (< 0.2% prevalence in adults aged 15 and above). The EU prevalence of trichiasis (TT) unknown to the health system in adults aged ≥15 years, ranged from 0.00% to 0.36%. In this EU, the estimated TT backlog is 417 All TT patients identified in the study, as well as through on-going surveillance efforts will require further management. A total of 75.9% (95% CI 72.1–79.3, EU range 29.1–92.6) of households defecated in the open but many households had access to an improved water source 75.9% (95%CI: 71.5–79.8, EU range 47.4–90.1%), with 45.5% (95% CI 41.5–49.7%, EU range 28.4–61.8%) making a round trip of water collection < 30 minutes.ConclusionThe findings from this survey indicate elimination thresholds have been maintained in Ghana in 17 of the 18 surveyed EUs. Only one EU, Yendi, did not achieve the TT elimination threshold. A scheduled house-by-house TT case search in this EU coupled with surgery to clear the backlog of cases is necessary in order for Ghana to request validation of elimination of trachoma as a public health problem.

Integrated Mapping of Yaws and Trachoma in the Five Northern-Most Provinces of Vanuatu.

Yaws and trachoma are targeted for eradication and elimination as public health problems. In trachoma-endemic populations mass administration of azithromycin can simultaneously treat yaws. We conducted a population-based prevalence survey in the five northernmost provinces of Vanuatu, where trachoma and yaws are suspected to be co-endemic. Clinical signs of trachoma were evaluated using the WHO simplified grading system, and skin examination with a serological rapid diagnostic test used to identify yaws. We enrolled 1004 households in 59 villages over 16 islands, and examined 3650 individuals of all ages for trachoma. The overall adjusted prevalence of trachomatous inflammation-follicular (TF) in 1–9 year-olds was 12.0% (95% Confidence Interval: 8.1–16.7%), and the overall adjusted prevalence of TT in those aged 15 years and greater was 0.04% (95% CI 0–0.14%). In multivariate analysis, the odds of children having TF was 2.6 (95% CI = 1.5–4.4) times higher in households with unimproved latrines, and independently associated with the number of children in the household (OR 1.3, 95% CI = 1.0–1.6 for each additional child). We examined the skin of 821 children aged 5–14 years. Two children had yaws, giving an estimated prevalence of active yaws in those aged 5–14 years of 0.2% (95% CI = 0.03–0.9%). Mass treatment with azithromycin is recommended in these provinces. Given the apparent low burden of yaws, integration of yaws and trachoma control programmes is likely to be useful and cost-effective to national programmes.

Chlamydia trachomatis as a cause of trachoma

Trachoma is keratoconjunctivitis caused by ocular infection with Chlamydia trachomatis. Endemic trachoma is caused by serovars A, B, Ba and C. Trachoma is probably the third most common cause of blindness worldwide, after cataracta and glaucoma. Active trachoma affects an estimated 84 million people; another 7.6 million have end-stage disease, of which about 1.3 million are blind. Most trachoma programmes use the WHO simplified grading system, by presence or absence of five clinical signs. The World Health Organization is leading a global effort to eliminate blinding trachoma by the year 2020, through the implementation of the SAFE strategy. This involves surgery for trichiasis (S-surgery), antibiotics for infection (A-antibiotic), facial cleanliness (F-face) and environmental improvements to reduce transmission of the organism (E-education). Treatment for trachoma includes local and systemic administration of appropriate antibiotics. Surgical correction of trachomatous trichiasis reduces the risk of progressive corneal opacification and blindness.

Follicular trachoma and trichiasis prevalence in an urban community in The Gambia, West Africa: is there a need to include urban areas in national trachoma surveillance?

Urban areas are traditionally excluded from trachoma surveillance activities, but due to rapid expansion and population growth, the urban area of Brikama in The Gambia may be developing social problems that are known risk factors for trachoma. It is also a destination for many migrants who may be introducing active trachoma into the area. This study aimed to determine the prevalence and risk factors for follicular trachoma and trichiasis in Brikama. A community-based cross-sectional prevalence survey including 27 randomly selected households in 12 randomly selected enumeration areas (EAs) of Brikama. Selected households were offered eye examinations, and the severity of trachoma was graded according to WHO's simplified grading system. Risk factor data were collected from each household via a questionnaire. The overall prevalence of trachomatous inflammation-follicular (TF) in children aged 1-9 years was 3.8% (95% CI 2.5-5.6), and the overall prevalence of trichiasis in adults aged ≥15 years was 0.46% (95% CI 0.17-1.14). EA prevalence of TF varied from 0% to 8.4%. The major risk factors for TF were dirty faces (P < 0.01, OR = 9.23, 95% CI 1.97-43.23), nasal discharge (P = 0.039, OR = 5.11, 95% CI 1.08-24.10) and residency in Brikama for <1 year (P = 0.047, OR = 7.78, 95% CI 1.03-59.03). Follicular trachoma can be considered to have been eliminated as a public health problem in Brikama according to WHO criteria. However, as the prevalence in some EAs is >5%, it may be prudent to include Brikama in surveillance programmes. Trichiasis remains a public health problem (>0.1%), and active case finding needs to be undertaken.

Trichiasis surgical coverage in three local government areas of Sokoto state, Nigeria

Community-based lid surgery for trachomatous trichiasis (TT) is provided in 8 local government areas (LGAs) of Sokoto state since 2003 as part of a trachoma control programme. This study aims to assess the impact of community-based lid surgery on the magnitude of TT in 3 LGAs of Sokoto state. A population-based survey was conducted in persons aged 15 years and above. A stratified multistage cluster sampling with probability proportional to size was used. Trachoma was assessed using the WHO simplified grading system. Despite high (13%) refusals, 72% of the minimum sample size was examined. The prevalence of blindness ranged from 1.3% to 2.5% in the LGAs while the prevalence of TT in persons aged 15 years and above was 2% in the Silame, 2.7% in the Wamakko and 5.6% in the Kware LGAs, respectively. The prevalence of TT in females 15 years and above was 1.1% in the Silame, 4% in the Wamakko and 6.3% in the Kware LGAs, respectively. The trichiasis surgical coverage is 9.5% in the Kware and 12.5% in the other LGAs respectively. The minimum number of TT lid surgery required to achieve the elimination level is 873 in the Silame LGA, 2611 in the Wamakko LGA and 4672 in the Kware LGA. The burden of TT is high in the study communities while the trichiasis surgical coverage is low. There is a need to strengthen the control programme to meet up with existing need.

The Prevalence of Blinding Trachoma in Northern States of Sudan

BackgroundDespite historical evidence of blinding trachoma, there have been no widespread contemporary surveys of trachoma prevalence in the northern states of Sudan. We aimed to conduct district-level surveys in this vast region in order to map the extent of the problem and estimate the need for trachoma control interventions to eliminate blinding trachoma.Methods and FindingsSeparate, population based cross-sectional surveys were conducted in 88 localities (districts) in 12 northern states of Sudan between 2006 and 2010. Two-stage cluster random sampling with probability proportional to size was used to select the sample. Trachoma grading was done using the WHO simplified grading system. Key prevalence indicators were trachomatous inflammation-follicular (TF) in children aged 1–9 years and trachomatous trichiasis (TT) in adults aged 15 years and above. The sample comprised 1,260 clusters from which 25,624 households were surveyed. A total of 106,697 participants (81.6% response rate) were examined for trachoma signs. TF prevalence was above 10% in three districts and between 5% and 9% in 11 districts. TT prevalence among adults was above 1% in 20 districts (which included the three districts with TF prevalence >10%). The overall number of people with TT in the population was estimated to be 31,072 (lower and upper bounds = 26,125–36,955).ConclusionTrachoma mapping is complete in the northern states of Sudan except for the Darfur States. The survey findings will facilitate programme planning and inform deployment of resources for elimination of trachoma from the northern states of Sudan by 2015, in accordance with the Sudan Federal Ministry of Health (FMOH) objectives.

Evaluation of the prevalence of trachoma 12 years after baseline surveys in Kidal Region, Mali

After prevalence surveys in all eight regions, Mali started a national programme to control trachoma in 1998. In the sparsely populated desert region of Kidal, where active trachoma prevalence was 46.2% in children under 10, no interventions beyond routine eye-care services were implemented. We estimated the prevalence of trachoma in Kidal, 12 years after baseline mapping surveys, to determine whether interventions to control trachoma were warranted. A total of 2165 individuals from 477 households were examined for clinical trachoma signs in a cluster survey using the WHO simplified grading system. Individual and household risk factors for trachoma were assessed. The prevalence of follicular trachomatous inflammation (TF) in children 1-9 years of age was 15.6% (95% CI 11.8-19.5%). Trachomatous trichiasis (TT) was observed in 4 persons for an overall prevalence in all ages of 0.16% (95% CI 0.0-0.35%). Estimated household latrine coverage in the region was 33.1% (95% CI 14.0-52.2%). Residents of 52.8% of surveyed households reported access to a water source outside geographical boundaries of their communities. In the absence of control interventions, the prevalence of clinical signs of trachoma among children was substantially lower than estimates 12 years earlier. The current prevalence of active trachoma remains above the threshold adopted by WHO, yet there is little evidence of chronic blinding trachoma.

Estimation of effects of community intervention with Antibiotics, Facial cleanliness, and Environmental improvement (A,F,E) in five districts of Ethiopia hyperendemic for trachoma

AimsThe WHO recommends the SAFE (surgery, antibiotics, facial cleanliness and environmental improvement) strategy for trachoma control. We aimed to investigate the association between active trachoma and community intervention with antibiotics,...

Blinding Trachoma in Katsina State, Nigeria: Population-Based Prevalence Survey in Ten Local Government Areas

Purpose: To assess the prevalence of trachomatous inflammation follicular (TF) in children aged 1–9 years and trachomatous trichiasis (TT) in adults aged 15 years or more in Katsina State, Nigeria. Methods: Cross sectional population-based trachoma prevalence surveys were conducted using multistage cluster random sampling methodology and the WHO simplified grading system for trachoma in ten local government areas (LGAs). Individual and household risk factors were recorded using a standard questionnaire. Results: A total of 11,407 children and 8,901 adults from 2,244 households were surveyed. Prevalence of TF in children aged 1–9 years ranged from 5.0 to 24.0%. Five LGAs exceeded the 10% threshold for intervention and a further three exceeded 10% in the 95% confidence limits. The prevalence of TT in adults aged 15 years or more ranged from 2.3 to 8.0%: all ten LGAs exceeded the 1% intervention threshold. Analysis of risk factors for active trachoma (TF and/or TI) in children showed the following significant independent associations: Presence of ocular discharge OR = 2.34 (95%CI 1.81–3.03); presence of nasal discharge OR = 1.44 (1.22–1.70); reported frequency of face washing once versus at least twice per day OR = 1.27 (1.02–1.58); disposal of trash inside the compound OR = 1.23 (1.02–1.48); and the absence of a household latrine OR = 1.43 (1.15–1.78). Conclusions: A trachoma control program is warranted in Katsina. Surgical interventions to correct TT are needed immediately in all LGAs surveyed and the full SAFE strategy is justified for five of the ten LGAs, and possibly for another three.

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

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. 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. 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. 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.