1
|
Tsang K, de Wildt G, Mwingira U, Mtuy TB. Implementing trachoma control programmes in marginalised populations in Tanzania: A qualitative study exploring the experiences and perspectives of key stakeholders. PLoS Negl Trop Dis 2021; 15:e0009727. [PMID: 34506482 PMCID: PMC8432809 DOI: 10.1371/journal.pntd.0009727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 08/14/2021] [Indexed: 11/19/2022] Open
Abstract
Background Despite aspects of the SAFE strategy for reducing trachoma in Tanzania have been somewhat successful, the disease still persists in marginalised communities even with repeated trachoma control interventions. This study aims to understand the facilitators and barriers associated with implementing trachoma control programmes in these communities, from the perspective of non-governmental organisations (NGOs). Methods Participants were the representatives of NGOs who had knowledge and experience in the implementation of trachoma control programmes. Data was collected using in-depth, semi-structured interviews guided by a topic guide, which was updated after each interview using a constant comparative method. Interviews were audio-recorded and then transcribed verbatim. Thematic analysis was done inductively. Codes were generated from the transcripts and then clustered into themes. Findings The context within marginalised communities often acted as a perceived barrier to successful implementation of control programmes. This included poor environmental cleanliness, lack of trust, poor disease knowledge and traditional lifestyles. Community values could either be a facilitator or a barrier, depending on the scenario. The anatomical location of the disease and the poor understanding of the disease progression also served as barriers. Considerations affecting decision-making among NGO’s include financial feasibility, community needs and whether the quality of the intervention could be improved. NGOs felt that the collaboration and the opportunity to learn from other organisations were beneficial aspects of having different actors. However, this also resulted in variability in the effectiveness of interventions between districts. Conclusion NGOs should focus on behaviour change and health education that is tailored to marginalised communities and seek innovative ways to implement trachoma intervention programmes whilst being minimally intrusive to the traditional way of life. Partners should also implement ways to ensure high quality programmes are being provided, by increasing staff accountability and compensating volunteers fairly. Trachoma is a neglected tropical disease caused by the bacterium Chlamydia trachomatis and can result in blindness if left untreated. The World Health Organisation devised the SAFE strategy (Surgery, Antibiotics, Facial Cleanliness and Environmental Improvements) to combat this disease. In Tanzania, many trachoma control interventions are implemented by non-governmental organisations (NGOs). The disease still persists in areas with marginalised, including Maasai, despite repeated interventions. These communities are often difficult to reach due to their livelihoods and local beliefs. This study investigates the facilitators and barriers to implementing interventions within hard to reach communities from the perspectives of NGOs. Findings will provide insight on how NGOs implement and ensure their programmes are effective, whilst being mindful of the intrinsic factors important to the community, which will inform improvements and alterations in trachoma interventions.
Collapse
Affiliation(s)
- Kaki Tsang
- The Department of Population Sciences and Humanities, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
- * E-mail:
| | - Gilles de Wildt
- The Department of Population Sciences and Humanities, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Upendo Mwingira
- RTI International, Washington DC, United States of America
- NTD Control Programme, National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Tara B. Mtuy
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| |
Collapse
|
2
|
Flueckiger RM, Stelmach R, Burgert-Brucker CR, Courtright P, Kabona G, Mosher AW, Mwingira UJ, Harding JC, Simon A, Ngondi J. Evaluating Precision of a Trachomatous Trichiasis (TT) Super Survey with Modulating Sample Sizes in Tanzania. Ophthalmic Epidemiol 2021; 29:394-400. [PMID: 34380006 DOI: 10.1080/09286586.2021.1950775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
As trachoma programs move towards eliminating trachoma as a public health problem, the number of surveys necessary to evaluate the status of trachomatous trichiasis (TT) increases. Currently, the World Health Organization endorses a district-level population-based prevalence survey for trachoma that involves a two-stage cluster design. We explored the validity of implementing this survey design in larger geographic areas to gain cost efficiencies. We evaluated the change in precision due to combining geographically contiguous and homogenous districts into single evaluation units (EUs) and modulating the sample size by running simulations on existing datasets. Preliminary findings from two opportunities in Tanzania show variability in the appropriateness in conducting this survey across larger geographies. These preliminary findings stress the importance of determining what is meant by homogeneity in terms of TT before combining multiple districts into a single EU.
Collapse
Affiliation(s)
- Rebecca M Flueckiger
- Global Health Division, International Development Group, RTI International, Washington, USA
| | - Rachel Stelmach
- Global Health Division, International Development Group, RTI International, Washington, USA
| | | | - Paul Courtright
- Kilimanjaro Centre for Community Ophthalmology, Division of Ophthalmology, University of Cape Town, Cape Town, South Africa
| | - George Kabona
- Neglected Tropical Disease Control Program, Ministry of Health and Social Welfare, Dar Es Salaam, Tanzania
| | - Aryc W Mosher
- Bureau for Global Health, United States Agency for International Development, Washington, USA
| | - Upendo J Mwingira
- Neglected Tropical Disease Control Program, Ministry of Health and Social Welfare, Dar Es Salaam, Tanzania
| | | | - Alistidia Simon
- Neglected Tropical Disease Control Program, Ministry of Health and Social Welfare, Dar Es Salaam, Tanzania
| | - Jeremiah Ngondi
- Global Health Division, International Development Group, RTI International, Dar Es Salaam, Tanzania
| |
Collapse
|
3
|
Mtuy TB, Mepukori J, Lankoi J, Lees S. Empowering Maasai women behind the camera: Photovoice as a tool for trachoma control. RESEARCH INVOLVEMENT AND ENGAGEMENT 2021; 7:51. [PMID: 34225822 PMCID: PMC8256559 DOI: 10.1186/s40900-021-00286-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 05/19/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Photovoice is a method used to help engage community members to understand local realities and promote social change. Photovoice uses cameras in the hands of participants as a tool to visually document a specified topic. Photos taken by participants allow for reflection and stimulate dialog on an issue to ideally lead to social change. Trachoma, hyperendemic in Maasai communities in Northern Tanzania, is the commonest infectious cause of blindness worldwide, caused by chlamydia trachomatis. The bacterial infection commonly occurs in childhood and over many years repeated infections leads to inflammation and scarring of the eyelid. Often as adults this leads to the upper eyelid turning inward and eyelashes scratching the eye, resulting in pain and eventually blindness. We used photovoice as a tool for Maasai women to share their lived experiences of educating peers on trachoma and ultimately empowering women in this society. METHODS This public engagement intervention was conducted September thru October 2017. We held a workshop on trachoma control for 20 Maasai women including use of photovoice method. Women were asked to disseminate information from the trachoma control workshop to their community and to capture their experiences using disposable cameras. Five weeks post-workshop we facilitated a discussion and women displayed photos of the successes and challenges they encountered as advocates for trachoma control in their community. INTERVENTION OUTCOMES It was observed throughout the process and at the photo discussion meeting, that women articulated empowerment by this experience; as educators, agents of change and a source of valued information. CONCLUSION Photovoice should be considered for future interventions as a communication tool on health issues and to empower women to be ambassadors for health promotion.
Collapse
Affiliation(s)
- Tara B Mtuy
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | | | | | - Shelley Lees
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| |
Collapse
|
4
|
Solomon AW, Hooper PJ, Bangert M, Mwingira UJ, Bakhtiari A, Brady MA, Fitzpatrick C, Jones I, Kabona G, Kello AB, Millar T, Mosher AW, Ngondi JM, Nshala A, Renneker K, Rotondo LA, Stelmach R, Harding-Esch EM, Malecela MN. The Importance of Failure: How Doing Impact Surveys That Fail Saves Trachoma Programs Money. Am J Trop Med Hyg 2020; 103:2481-2487. [PMID: 33025878 PMCID: PMC7695084 DOI: 10.4269/ajtmh.20-0686] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Trachoma programs use annual antibiotic mass drug administration (MDA) in evaluation units (EUs) that generally encompass 100,000–250,000 people. After one, three, or five MDA rounds, programs undertake impact surveys. Where impact survey prevalence of trachomatous inflammation—follicular (TF) in 1- to 9-year-olds is ≥ 5%, ≥ 1 additional MDA rounds are recommended before resurvey. Impact survey costs, and the proportion of impact surveys returning TF prevalence ≥ 5% (the failure rate or, less pejoratively, the MDA continuation rate), therefore influence the cost of eliminating trachoma. We modeled, for illustrative EU sizes, the financial cost of undertaking MDA with and without conducting impact surveys. As an example, we retrospectively assessed how conducting impact surveys affected costs in the United Republic of Tanzania for 2017–2018. For EUs containing 100,000 people, the median (interquartile range) cost of continuing MDA without doing impact surveys is USD 28,957 (17,581–36,197) per EU per year, whereas continuing MDA solely where indicated by impact survey results costs USD 17,564 (12,158–21,694). If the mean EU population is 100,000, then continuing MDA without impact surveys becomes advantageous in financial cost terms only when the continuation rate exceeds 71%. For the United Republic of Tanzania in 2017–2018, doing impact surveys saved enough money to provide MDA for > 1,000,000 people. Although trachoma impact surveys have a nontrivial cost, they generally save money, providing EUs have > 50,000 inhabitants, the continuation rate is not excessive, and they generate reliable data. If all EUs pass their impact surveys, then we have waited too long to do them.
Collapse
Affiliation(s)
- Anthony W Solomon
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Pamela J Hooper
- Task Force for Global Health, International Trachoma Initiative, Atlanta, Georgia
| | - Mathieu Bangert
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Upendo J Mwingira
- Neglected Tropical Disease Control Program, Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, United Republic of Tanzania
| | - Ana Bakhtiari
- Task Force for Global Health, International Trachoma Initiative, Atlanta, Georgia
| | | | - Christopher Fitzpatrick
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Iain Jones
- Sightsavers, Haywards Heath, United Kingdom
| | - George Kabona
- Neglected Tropical Disease Control Program, Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, United Republic of Tanzania
| | - Amir B Kello
- Expanded Special Project for Elimination of Neglected Tropical Diseases, World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Tom Millar
- Sightsavers, Haywards Heath, United Kingdom
| | - Aryc W Mosher
- United States Agency for International Development, Washington, District of Columbia
| | | | - Andreas Nshala
- Department of International Maternal and Child Health, Faculty of Medicine and Pharmacy, University of Uppsala, Uppsala, Sweden.,IMA World Health, Dar es Salaam, United Republic of Tanzania
| | - Kristen Renneker
- Task Force for Global Health, International Trachoma Initiative, Atlanta, Georgia
| | | | | | - Emma M Harding-Esch
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Mwelecele N Malecela
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| |
Collapse
|
5
|
Understanding hard-to-reach communities: local perspectives and experiences of trachoma control among the pastoralist Maasai in northern Tanzania. J Biosoc Sci 2020; 53:819-838. [PMID: 32981544 DOI: 10.1017/s0021932020000553] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
As progress to eliminate trachoma is made, addressing hard-to-reach communities becomes of greater significance. Areas in Tanzania, inhabited by the Maasai, remain endemic for trachoma. This study assessed the effectiveness of Mass Drug Administration (MDA) through an ethnographic study of trachoma amongst a Maasai community. The MDA experience in the context of the livelihoods of the Maasai in a changing political economy was explored using participant observation and household interviews. Factors influencing MDA effectiveness within five domains were analysed. 1) Terrain of intervention: Human movement hindered MDA, including seasonal migration, domestic chores, grazing and school. Encounters with wildlife were significant. 2) Socio-cultural factors and community agency: Norms around pregnancy led women to accept the drug but hide refusal to swallow the drug. Timing of Community Drug Distributor (CDD) visits conflicted with livestock grazing. Refusals occurred among the ilmurrani age group and older women. Mistrust significantly hindered uptake of drugs. 3) Strategies and motivation of drug distributors: Maa-speaking CDDs were critical to effective drug delivery. Maasai CDDs, whilst motivated, faced challenges of distances, encounters with wildlife and compensation. 4) Socio-materiality of technology: Decreases in side-effects over years have improved trust in the drug. Restrictions to swallowing drugs and/or water were relevant to post-partum women and the ilmurrani. 5) History and health governance: Whilst perceptions of the programme were positive, communities questioned government priorities for resources for hospitals, medicines, clean water and roads. They complained of a lack of information and involvement of community members in health care services. With elimination in sight, hard-to-reach communities are paramount as these are probably the last foci of infection. Effective delivery of MDA programmes in such communities requires a critical understanding of community experiences and responses that can inform tailored approaches to trachoma control. Application of a critical social science perspective should be embedded in planning and evaluation of all NTD programmes.
Collapse
|
6
|
Flueckiger RM, Courtright P, Abdala M, Abdou A, Abdulnafea Z, Al-Khatib TK, Amer K, Amiel ON, Awoussi S, Bakhtiari A, Batcho W, Bella AL, Bennawi KH, Brooker SJ, Chu BK, Dejene M, Dezoumbe D, Elshafie BE, Elvis AA, Fabrice DN, Omar FJ, François M, François D, Garap J, Gichangi M, Goepogui A, Hammou J, Kadri B, Kabona G, Kabore M, Kalua K, Kamugisha M, Kebede B, Keita K, Khan AA, Kiflu G, Yibi M, Mackline G, Macleod C, Manangazira P, Masika MP, Massangaie M, Mduluza T, Meno N, Midzi N, Minnih AO, Mishra S, Mpyet C, Muraguri N, Mwingira U, Nassirou B, Ndjemba J, Nieba C, Ngondi J, Olobio N, Pavluck A, Phiri I, Pullan R, Qureshi B, Sarr B, Seiha D, Chávez GMS, Sharma S, Sisaleumsak S, Southisombath K, Stevens G, Woldendrias AT, Traoré L, Turyaguma P, Willis R, Yaya G, Yeo S, Zambroni F, Zhao J, Solomon AW. The global burden of trichiasis in 2016. PLoS Negl Trop Dis 2019; 13:e0007835. [PMID: 31765415 PMCID: PMC6901231 DOI: 10.1371/journal.pntd.0007835] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 12/09/2019] [Accepted: 10/08/2019] [Indexed: 11/19/2022] Open
Abstract
Background Trichiasis is present when one or more eyelashes touches the eye. Uncorrected, it can cause blindness. Accurate estimates of numbers affected, and their geographical distribution, help guide resource allocation. Methods We obtained district-level trichiasis prevalence estimates in adults for 44 endemic and previously-endemic countries. We used (1) the most recent data for a district, if more than one estimate was available; (2) age- and sex-standardized corrections of historic estimates, where raw data were available; (3) historic estimates adjusted using a mean adjustment factor for districts where raw data were unavailable; and (4) expert assessment of available data for districts for which no prevalence estimates were available. Findings Internally age- and sex-standardized data represented 1,355 districts and contributed 662 thousand cases (95% confidence interval [CI] 324 thousand–1.1 million) to the global total. Age- and sex-standardized district-level prevalence estimates differed from raw estimates by a mean factor of 0.45 (range 0.03–2.28). Previously non- stratified estimates for 398 districts, adjusted by ×0.45, contributed a further 411 thousand cases (95% CI 283–557 thousand). Eight countries retained previous estimates, contributing 848 thousand cases (95% CI 225 thousand-1.7 million). New expert assessments in 14 countries contributed 862 thousand cases (95% CI 228 thousand–1.7 million). The global trichiasis burden in 2016 was 2.8 million cases (95% CI 1.1–5.2 million). Interpretation The 2016 estimate is lower than previous estimates, probably due to more and better data; scale-up of trichiasis management services; and reductions in incidence due to lower active trachoma prevalence. As an individual with trichiasis blinks, the eyelashes abrade the cornea, which can lead to corneal opacity and blindness. Through high quality surgery, which involves altering the position of the eyelid margin, it is possible to reduce the number of people with trichiasis. Accurate estimates of the number of persons with trichiasis and their geographical distribution are needed in order to effectively align resources for surgery and other necessary services. We obtained district-level trichiasis prevalence estimates for 44 endemic and previously-endemic countries. We used the most recently available data and expert assessments to estimate the global burden of trichiasis. We estimated that in 2016 the global burden was 2.8 million cases (95% CI 1.1–5.2 million). The 2016 estimate is lower than previous estimates, probably due to more and better data; scale-up of trichiasis management services; and reductions in incidence due to lower active trachoma prevalence.
Collapse
Affiliation(s)
- Rebecca M. Flueckiger
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Paul Courtright
- Kilimanjaro Centre for Community Ophthalmology, Division of Ophthalmology, University of Cape Town, Cape Town, South Africa
| | - Mariamo Abdala
- Ministerio da Saude, National Ophthalmology Program, Maputo, Mozambique
| | - Amza Abdou
- Ministère de la Santé et de la population, Niamey, Niger
| | | | - Tawfik K. Al-Khatib
- National Eye Health Programme, Ministry of Public Health and Population, Sana’a, Yemen
| | | | | | | | | | | | | | | | - Simon J. Brooker
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Global Health, Neglected Tropical Diseases, Bill & Melinda Gates Foundation, Seattle, USA
| | - Brian K. Chu
- The Task Force for Global Health, Atlanta, GA, USA
| | - Michael Dejene
- Michael Dejene Public Health Consultancy Services, Addis Ababa, Ethiopia
| | | | | | - Aba Ange Elvis
- Programme National de la Santé Oculaire et de la lutte contre l'Onchocercose, Abidjan, Côte d'Ivoire
| | | | | | - Missamou François
- Bureau des Maladies Oculaires, Ministère de la Santé, Kinshasa, Democratic Republic of the Congo
| | - Drabo François
- Programme national de lutte contre les maladies tropicales négligées (PNMTN), Ouagadougou, Burkina Faso
| | - Jambi Garap
- National Department of Health, Port Moresby, Papua New Guinea
| | | | - André Goepogui
- Programme National de Lutte Contre l’Onchocercose et la Cécité et les Maladies Tropicales Négligées, Conakry, Guinea
| | | | - Boubacar Kadri
- Ministère de la Santé et de la population, Niamey, Niger
| | - George Kabona
- Ministry of Health, Dar es Salaam, United Republic of Tanzania
| | - Martin Kabore
- l'unité d'élimination du trachome, PNMTN, Ouagadougou, Burkina Faso
| | - Khumbo Kalua
- Department of Ophthalmology, University of Malawi, College of Medicine, Blantyre, Malawi
| | - Mathias Kamugisha
- National Institute for Medical Research, Dar es Salaam, United Republic of Tanzania
| | | | - Kaba Keita
- Programme National de Lutte Contre l’Onchocercose et la Cécité et les Maladies Tropicales Négligées, Conakry, Guinea
| | | | - Genet Kiflu
- Federal Ministry of Health, Addis Ababa, Ethiopia
| | | | | | - Colin Macleod
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Portia Manangazira
- Department of Epidemiology and Disease Control, Ministry of Health & Child Welfare, Harare, Zimbabwe
| | | | - Marilia Massangaie
- Ministerio da Saude, Department of Neglected Tropical Diseases, Maputo, Mozambique
| | - Takafira Mduluza
- Department of Biochemistry, University of Zimbabwe, Harare, Zimbabwe
| | | | - Nicholas Midzi
- Department of Medical Microbiology, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | | | | | - Caleb Mpyet
- Sightsavers Nigeria, Kaduna, Nigeria & Department of Ophthalmology, Jos University, Jos, Nigeria
| | | | - Upendo Mwingira
- Ministry of Health, Dar es Salaam, United Republic of Tanzania
| | - Beido Nassirou
- Ministère de la Santé et de la population, Niamey, Niger
| | - Jean Ndjemba
- Bureau des Maladies Oculaires, Ministère de la Santé, Kinshasa, Democratic Republic of the Congo
| | - Cece Nieba
- Programme National de Lutte Contre l’Onchocercose et la Cécité et les Maladies Tropicales Négligées, Conakry, Guinea
| | - Jeremiah Ngondi
- RTI International, Dar es Salaam, United Republic of Tanzania
| | | | | | - Isaac Phiri
- Department of Epidemiology and Disease Control, Ministry of Health & Child Welfare, Harare, Zimbabwe
| | - Rachel Pullan
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Boubacar Sarr
- Ministère de la santé et de l’Action Sociale, Dakar, Senegal
| | - Do Seiha
- Prevention of Blindness Programme, Ministry of Health, Phnom Penh, Cambodia
| | | | | | | | - Khamphoua Southisombath
- National Program for the Prevention of Blindness, Ministry of Health, Vientiane, Lao People’s Democratic Republic
| | - Gretchen Stevens
- Department of Information, Evidence and Research, World Health Organization, Geneva, Switzerland
| | | | | | | | | | - Georges Yaya
- Ministère de la Santé Publique, Bangui, Central African Republic
| | - Souleymane Yeo
- Programme National de la Santé Oculaire et de la lutte contre l'Onchocercose, Abidjan, Côte d'Ivoire
| | | | - Jialiang Zhao
- Department of Ophthalmology, Peking Union Medical Colllege Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Anthony W. Solomon
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| |
Collapse
|
7
|
Solomon AW, Willis R, Pavluck AL, Alemayehu W, Bakhtiari A, Bovill S, Chu BK, Courtright P, Dejene M, Downs P, Flueckiger RM, Haddad D, Hooper PJ, Kalua K, Kebede B, Kello AB, Macleod CK, McCullagh S, Millar T, Mpyet C, Ngondi J, Nwobi B, Olobio N, Onyebuchi U, Rotondo LA, Sarr B, Shafi O, Sokana O, West SK, Foster A, For The Global Trachoma Mapping Project. Quality Assurance and Quality Control in the Global Trachoma Mapping Project. Am J Trop Med Hyg 2019; 99:858-863. [PMID: 30039782 PMCID: PMC6159583 DOI: 10.4269/ajtmh.18-0082] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
In collaboration with the health ministries that we serve and other partners, we set out to complete the multiple-country Global Trachoma Mapping Project. To maximize the accuracy and reliability of its outputs, we needed in-built, practical mechanisms for quality assurance and quality control. This article describes how those mechanisms were created and deployed. Using expert opinion, computer simulation, working groups, field trials, progressively accumulated in-project experience, and external evaluations, we developed 1) criteria for where and where not to undertake population-based prevalence surveys for trachoma; 2) three iterations of a standardized training and certification system for field teams; 3) a customized Android phone–based data collection app; 4) comprehensive support systems; and 5) a secure end-to-end pipeline for data upload, storage, cleaning by objective data managers, analysis, health ministry review and approval, and online display. We are now supporting peer-reviewed publication. Our experience shows that it is possible to quality control and quality assure prevalence surveys in such a way as to maximize comparability of prevalence estimates between countries and permit high-speed, high-fidelity data processing and storage, while protecting the interests of health ministries.
Collapse
Affiliation(s)
- Anthony W Solomon
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom.,London Centre for Neglected Tropical Disease Research, London, United Kingdom
| | | | | | - Wondu Alemayehu
- Berhan Public Health and Eye Care Consultancy, Addis Adaba, Ethiopia.,The Fred Hollows Foundation Ethiopia, Addis Ababa, Ethiopia
| | | | - Sarah Bovill
- Sightsavers, Haywards Heath, West Sussex, United Kingdom
| | - Brian K Chu
- Task Force for Global Health, Decatur, Georgia
| | - Paul Courtright
- ilimanjaro Centre for Community Ophthalmology, Division of Ophthalmology, University of Cape Town, Cape Town, South Africa
| | - Michael Dejene
- Michael Dejene Public Health Consultancy Services, Addis Ababa, Ethiopia
| | - Philip Downs
- Sightsavers, Haywards Heath, West Sussex, United Kingdom
| | | | - Danny Haddad
- Orbis International, New York, New York.,Emory Eye Center, Atlanta, Georgia
| | - P J Hooper
- Task Force for Global Health, Decatur, Georgia
| | - Khumbo Kalua
- Blantyre Institute for Community Outreach, Blantyre, Malawi
| | | | - Amir Bedri Kello
- Light for the World, Addis Ababa, Ethiopia.,ilimanjaro Centre for Community Ophthalmology, Division of Ophthalmology, University of Cape Town, Cape Town, South Africa
| | | | | | - Tom Millar
- Sightsavers, Haywards Heath, West Sussex, United Kingdom
| | - Caleb Mpyet
- Department of Ophthalmology, Jos University, Jos, Nigeria.,Sightsavers Nigeria, Kaduna, Nigeria.,ilimanjaro Centre for Community Ophthalmology, Division of Ophthalmology, University of Cape Town, Cape Town, South Africa
| | - Jeremiah Ngondi
- RTI International, Washington, District of Columbia.,The Carter Center, Atlanta, Georgia
| | - Benjamin Nwobi
- National Trachoma Control Program, Department of Public Health, Federal Ministry of Health, Abuja, Nigeria
| | - Nicholas Olobio
- National Trachoma Control Program, Department of Public Health, Federal Ministry of Health, Abuja, Nigeria
| | - Uwazoeke Onyebuchi
- National Trachoma Control Program, Department of Public Health, Federal Ministry of Health, Abuja, Nigeria
| | | | - Boubacar Sarr
- Ministère de la Santé et de la Prévention Médicale, Dakar, Senegal
| | - Oumer Shafi
- Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Oliver Sokana
- Eyecare Department, Ministry of Health, Honiara, Solomon Islands
| | - Sheila K West
- Dana Center for Preventive Ophthalmology, The Wilmer Institute, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Allen Foster
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | |
Collapse
|
8
|
Missamou F, Marlhand H, Dzabatou-Babeaux ASP, Sendzi S, Bernasconi J, D'Souza S, Bakhtiari A, Millar T, Willis R, Bengraïne K, Resnikoff S, Solomon AW. A Population-Based Trachoma Prevalence Survey Covering Seven Districts of Sangha and Likouala Departments, Republic of the Congo. Ophthalmic Epidemiol 2019; 25:155-161. [PMID: 30806542 PMCID: PMC6444200 DOI: 10.1080/09286586.2018.1546878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE We set out to estimate the prevalence of trachoma and access to water and sanitation in seven suspected-trachoma-endemic districts of northern Congo, surveyed as a single evaluation unit. METHODS From a complete list of rural villages in the seven districts, we systematically selected 22 with probability proportional to village size. In selected villages, we included all households where there were fewer than 25 in total, or used compact segment sampling to select a group of approximately 20 households by random draw. In each selected household, all consenting residents aged ≥1 year were examined by Global Trachoma Mapping Project-certified trachoma graders, and data collected on household-level access to water and sanitation. RESULTS In November and December 2015, 466 households were visited in 22 villages, and 2081 (88%) of 2377 residents of those households were examined. No examined individual had trichiasis. The age-adjusted prevalence of the active trachoma sign trachomatous inflammation-follicular (TF) in 1-9-year-olds was 2.5% (95%CI 0.9-4.5%). Only 39% (95%CI 35-44%) of households had access to an improved source of drinking water. Only 10% (95%CI 7-13%) of households had access to an improved sanitation facility. CONCLUSION Trachoma is not a public health problem in this part of Congo. Access to water and sanitation is inadequate.
Collapse
Affiliation(s)
- François Missamou
- a Directorate-General for the Fight against Communicable Diseases and HIV/AIDS , Ministère de la Santé et de la Population , Brazzaville , Congo
| | - Hemilembolo Marlhand
- a Directorate-General for the Fight against Communicable Diseases and HIV/AIDS , Ministère de la Santé et de la Population , Brazzaville , Congo
| | - Angelie S Patrick Dzabatou-Babeaux
- a Directorate-General for the Fight against Communicable Diseases and HIV/AIDS , Ministère de la Santé et de la Population , Brazzaville , Congo
| | - Samuel Sendzi
- a Directorate-General for the Fight against Communicable Diseases and HIV/AIDS , Ministère de la Santé et de la Population , Brazzaville , Congo
| | | | | | | | | | | | - Karim Bengraïne
- b Organisation pour la prevention de la cécité , Paris , France
| | - Serge Resnikoff
- b Organisation pour la prevention de la cécité , Paris , France
| | - Anthony W Solomon
- e Clinical Research Department , London School of Hygiene & Tropical Medicine , London , UK.,f Department of Control of Neglected Tropical Diseases , World Health Organization , Geneva , Switzerland
| |
Collapse
|
9
|
Hiep NX, Ngondi JM, Anh VT, Dat TM, An TV, Dung NC, Thang ND, Chu BK, Willis R, Bakhtiari A, Pavluck AL, Johnson J, Sidwell J, Brady M, Henry R, Mosher A, Porco TC, Lietman TM, Rotondo LA, Lewallen S, Courtright P, Solomon AW. Trachoma in Viet Nam: results of 11 surveillance surveys conducted with the Global Trachoma Mapping Project. Ophthalmic Epidemiol 2019; 25:93-102. [PMID: 30806534 PMCID: PMC6444206 DOI: 10.1080/09286586.2018.1477964] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Purpose: Following interventions against trachoma in Viet Nam, impact surveys conducted in 2003–2011 suggested that trachoma was no longer a public health problem. In 2014, we undertook surveillance surveys to estimate prevalence of trachomatous inflammation—follicular (TF) and trichiasis. Methods: A population-based prevalence survey was undertaken in 11 evaluation units (EUs) encompassing 24 districts, using Global Trachoma Mapping Project methods. A two-stage cluster sampling design was used in each EU, whereby 20 clusters and 60 children per cluster were sampled. Consenting eligible participants (children aged 1–9 years and adults aged ≥50 years) were examined for trachoma. Results: A total of 9391 households were surveyed, and 20,185 participants (98.8% of those enumerated) were examined for trachoma. EU-level TF prevalence in 1–9-year-olds ranged from 0% to 1.6%. In one cluster (in Hà Giang Province), the percentage of children with TF was 10.3%. The overall pattern of cluster-level percentages of children with TF, however, was consistent with an exponential distribution, which would be consistent with trachoma disappearing. Among people aged ≥50 years, prevalence of trichiasis by EU ranged from 0% to 0.75%; these estimates are equivalent to 0–0.13% in all ages. The prevalence of trichiasis unknown to the health system among people aged ≥50 years, by EU, ranged from 0% to 0.17%, which is equivalent to 0–0.03% in all ages. Conclusion: Findings suggest that trachoma is no longer a public health problem in any of the 11 EUs surveyed. However, given the high proportion of children with TF in one cluster in Hà Giang Province, further investigations will be undertaken.
Collapse
Affiliation(s)
- Nguyen Xuan Hiep
- a Viet Nam Institute of Ophthalmology, Ministry of Health , Hanoi , Viet Nam
| | | | - Vu Tuan Anh
- a Viet Nam Institute of Ophthalmology, Ministry of Health , Hanoi , Viet Nam
| | - Tran Minh Dat
- a Viet Nam Institute of Ophthalmology, Ministry of Health , Hanoi , Viet Nam
| | - Tran Van An
- a Viet Nam Institute of Ophthalmology, Ministry of Health , Hanoi , Viet Nam
| | - Nguyen Chi Dung
- a Viet Nam Institute of Ophthalmology, Ministry of Health , Hanoi , Viet Nam
| | - Nguyen Duy Thang
- a Viet Nam Institute of Ophthalmology, Ministry of Health , Hanoi , Viet Nam
| | - Brian K Chu
- c Task Force for Global Health , Decatur , GA , USA
| | | | | | | | | | | | | | - Rob Henry
- f United States Agency for International Development , Washington , DC , USA
| | - Aryc Mosher
- f United States Agency for International Development , Washington , DC , USA
| | - Travis C Porco
- g F.I. Proctor Foundation , San Francisco , CA , USA.,h Department of Ophthalmology , San Francisco , CA , USA.,i Department of Epidemiology & Biostatistics , University of California , San Francisco , CA , USA
| | - Thomas M Lietman
- g F.I. Proctor Foundation , San Francisco , CA , USA.,h Department of Ophthalmology , San Francisco , CA , USA.,i Department of Epidemiology & Biostatistics , University of California , San Francisco , CA , USA
| | | | - Susan Lewallen
- j Kilimanjaro Center for Community Ophthalmology, Division of Ophthalmology , University of Cape Town , Cape Town , South Africa
| | - Paul Courtright
- j Kilimanjaro Center for Community Ophthalmology, Division of Ophthalmology , University of Cape Town , Cape Town , South Africa
| | - Anthony W Solomon
- k Clinical Research Department , London School of Hygiene & Tropical Medicine , London , UK.,l London Centre for Neglected Tropical Disease Research , London , UK
| | | |
Collapse
|
10
|
Mpyet C, Muhammad N, Adamu MD, Ladan M, Willis R, Umar MM, Alada J, Aliero AA, Bakhtiari A, Flueckiger RM, Olobio N, Nwosu C, Damina M, Gwom A, Labbo AA, Boisson S, Isiyaku S, William A, Rabiu MM, Pavluck AL, Gordon BA, Solomon AW. Impact Survey Results after SAFE Strategy Implementation in 15 Local Government Areas of Kebbi, Sokoto and Zamfara States, Nigeria. Ophthalmic Epidemiol 2019; 25:103-114. [PMID: 30806537 PMCID: PMC6444276 DOI: 10.1080/09286586.2018.1481984] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Purpose: To determine prevalence of trachoma after interventions in 15 local government areas (LGAs) of Kebbi, Sokoto and Zamfara States, Nigeria. Methods: A population-based impact survey was conducted in each LGA using Global Trachoma Mapping Project (GTMP) protocols. In each LGA, 25 villages were selected, except in Arewa LGA, where we selected 25 villages from each of four subunits to obtain finer-resolution prevalence information. Villages were selected with probability proportional to size. In each village, 25 households were enrolled and all consenting residents aged ≥1 year were examined by GTMP-certified graders for trachomatous inflammation—follicular (TF) and trachomatous trichiasis (TT). Information on sources of household water and types of sanitation facilities used was collected through questioning and direct observation. Results: The number of households enrolled per LGA ranged from 623 (Kware and Tangaza) to 2488 (Arewa). There have been marked reductions in the prevalence of TF and TT since baseline surveys were conducted in all 15 LGAs. Eight of the 15 LGAs have attained TF prevalences <5% in children, while 10 LGAs have attained TT prevalences <0.2% in persons aged ≥15 years. Between 49% and 96% of households had access to water for hygiene purposes within 1 km of the household, while only 10–59% had access to improved sanitation facilities. Conclusion: Progress towards elimination of trachoma has been made in these 15 LGAs. Collaboration with water and sanitation agencies and community-based trichiasis surgery are still needed in order to eliminate trachoma by the year 2020.
Collapse
Affiliation(s)
- Caleb Mpyet
- a Department of Ophthalmology , Jos University Teaching Hospital , Jos , Nigeria.,b Sightsavers , Kaduna , Nigeria.,c Kilimanjaro Centre for Community Ophthalmology, Division of Ophthalmology , University of Cape Town , Cape Town , South Africa
| | - Nasiru Muhammad
- d Ophthalmology Unit, Surgery Department , Usmanu Dan Fodiyo University , Sokoto , Nigeria
| | - Mohammed Dantani Adamu
- d Ophthalmology Unit, Surgery Department , Usmanu Dan Fodiyo University , Sokoto , Nigeria
| | | | | | | | - Joel Alada
- a Department of Ophthalmology , Jos University Teaching Hospital , Jos , Nigeria.,h Department of Ophthalmology , Jos University Teaching Hospital , Jos , Nigeria
| | | | | | | | - Nicholas Olobio
- j National Trachoma Control Program, Department of Public Health , Federal Ministry of Health , Abuja , Nigeria
| | | | | | | | | | - Sophie Boisson
- l Department of Public Health, the Environment and Social Determinants of Health , World Health Organization , Geneva , Switzerland
| | | | | | | | | | - Bruce A Gordon
- l Department of Public Health, the Environment and Social Determinants of Health , World Health Organization , Geneva , Switzerland
| | - Anthony W Solomon
- n Clinical Research Department , London School of Hygiene & Tropical Medicine , London , United Kingdom.,o London Centre for Neglected Tropical Disease Research , London , United Kingdom.,p Department of Control of Neglected Tropical Diseases , World Health Organization , Geneva , Switzerland
| | | |
Collapse
|
11
|
Baayenda G, Mugume F, Turyaguma P, Tukahebwa EM, Binagwa B, Onapa A, Agunyo S, Osilo MK, French MD, Thuo W, Rotondo LA, Renneker K, Willis R, Bakhtiari A, Harding-Esch EM, Solomon AW, Ngondi JM. Completing Baseline Mapping of Trachoma in Uganda: Results of 14 Population-Based Prevalence Surveys Conducted in 2014 and 2018. Ophthalmic Epidemiol 2018; 25:162-170. [PMID: 30806547 PMCID: PMC6444199 DOI: 10.1080/09286586.2018.1546879] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 10/02/2018] [Accepted: 11/06/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE We aimed to estimate the prevalence of trachomatous inflammation-follicular (TF) in children aged 1-9 years, trichiasis in adults aged ≥15 years, and water and sanitation (WASH) indicators in 12 suspected-endemic districts in Uganda. METHODS Surveys were undertaken in 14 evaluation units (EUs) covering 12 districts. Districts were selected based on a desk review in 2014 (four districts) and trachoma rapid assessments in 2018 (eight districts). We calculated that 1,019 children aged 1-9 years were needed in each EU to estimate TF prevalence with acceptable precision and used three-stage cluster sampling to select 30 households in each of 28 (2014 surveys) or 24 (2018 surveys) villages. Participants living in selected households aged ≥1 year were examined for trachoma; thus enabling estimation of prevalences of TF in 1-9 year-olds and trichiasis in ≥15 year-olds. Household-level WASH access data were also collected. RESULTS A total of 11,796 households were surveyed; 22,465 children aged 1-9 years and 24,652 people aged ≥15 years were examined. EU-level prevalence of TF ranged from 0.3% (95% confidence interval [CI] 0.1-0.7) to 3.9% (95% CI 2.1-5.8). EU-level trichiasis prevalence ranged from 0.01% (95% CI 0-0.11) to 0.81% (95% CI 0.35-1.50). Overall proportions of households with improved drinking water source, water source in yard or within 1km, and improved sanitation facilities were 88.1%, 23.0% and 23.9%, respectively. CONCLUSION TF was not a public health problem in any of the 14 EUs surveyed: antibiotic mass drug administration is not required in these districts. However, in four EUs, trichiasis prevalence was ≥ 0.2%, so public health-level trichiasis surgery interventions are warranted. These findings will facilitate planning for elimination of trachoma in Uganda.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Emma M. Harding-Esch
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Anthony W. Solomon
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | | |
Collapse
|
12
|
Trotignon G, Jones E, Engels T, Schmidt E, McFarland DA, Macleod CK, Amer K, Bio AA, Bakhtiari A, Bovill S, Doherty AH, Khan AA, Mbofana M, McCullagh S, Millar T, Mwale C, Rotondo LA, Weaver A, Willis R, Solomon AW. The cost of mapping trachoma: Data from the Global Trachoma Mapping Project. PLoS Negl Trop Dis 2017; 11:e0006023. [PMID: 29045419 PMCID: PMC5675456 DOI: 10.1371/journal.pntd.0006023] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 11/07/2017] [Accepted: 10/09/2017] [Indexed: 11/18/2022] Open
Abstract
Background The Global Trachoma Mapping Project (GTMP) was implemented with the aim of completing the baseline map of trachoma globally. Over 2.6 million people were examined in 1,546 districts across 29 countries between December 2012 and January 2016. The aim of the analysis was to estimate the unit cost and to identify the key cost drivers of trachoma prevalence surveys conducted as part of GTMP. Methodology and principal findings In-country and global support costs were obtained using GTMP financial records. In-country expenditure was analysed for 1,164 districts across 17 countries. The mean survey cost was $13,113 per district [median: $11,675; IQR = $8,365-$14,618], $17,566 per evaluation unit [median: $15,839; IQR = $10,773-$19,915], $692 per cluster [median: $625; IQR = $452-$847] and $6.0 per person screened [median: $4.9; IQR = $3.7-$7.9]. Survey unit costs varied substantially across settings, and were driven by parameters such as geographic location, demographic characteristics, seasonal effects, and local operational constraints. Analysis by activities showed that fieldwork constituted the largest share of in-country survey costs (74%), followed by training of survey teams (11%). The main drivers of in-country survey costs were personnel (49%) and transportation (44%). Global support expenditure for all surveyed districts amounted to $5.1m, which included grant management, epidemiological support, and data stewardship. Conclusion This study provides the most extensive analysis of the cost of conducting trachoma prevalence surveys to date. The findings can aid planning and budgeting for future trachoma surveys required to measure the impact of trachoma elimination activities. Furthermore, the results of this study can also be used as a cost basis for other disease mapping programmes, where disease or context-specific survey cost data are not available. There are currently few data sets available to aid programmes in planning and budgeting for population-based surveys in low- and middle- income countries. With the objective of identifying cost drivers and key variables influencing prevalence survey costs, the authors collected expenses incurred during the Global Trachoma Mapping Project (GTMP) which surveyed 2.6 million people across 29 countries. Expenditure from surveying 1,164 districts in 17 countries was analysed. Our results showed that the majority of in-country expenditure was spent on personnel (per diems, accommodation, meals and beverages) (49%) and local transportation (44%) and that the median survey expenditure was US$11,675 per district (or US$15,839 per evaluation unit, US$625 per cluster and US$4.9 per person examined). There were large variations in survey unit costs across settings, based on local geographic, demographic, seasonal effects and local operational characteristics. In addition, the resources required for the global support and coordination of the GTMP were analysed and amounted to US$5.1m (US$3,318 per district or US$5,668 per EU). Global support expenses can be substantial for a large multi-country mapping exercise conducted in a limited period of time such as the GTMP. Findings from this study can be used to inform other disease mapping projects, and to inform planning and budgeting for the prevalence surveys that will assess the impact of trachoma elimination interventions.
Collapse
Affiliation(s)
| | - Ellen Jones
- Neglected Tropical Diseases Department, Sightsavers, Haywards Heath, United Kingdom
| | - Thomas Engels
- Research Department, Sightsavers, Haywards Heath, United Kingdom
| | - Elena Schmidt
- Research Department, Sightsavers, Haywards Heath, United Kingdom
| | - Deborah A. McFarland
- Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Colin K. Macleod
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Khaled Amer
- Prevention of Blindness Programme, Ministry of Health, Cairo, Egypt
| | - Amadou A. Bio
- Programme National de Lutte Contre les Maladies Transmissibles, Ministère de la Santé, Cotonou, Benin
| | - Ana Bakhtiari
- Task Force for Global Health, Atlanta, GA, United States of America
| | - Sarah Bovill
- Neglected Tropical Diseases Department, Sightsavers, Haywards Heath, United Kingdom
| | - Amy H. Doherty
- RTI International, Washington, D.C., United States of America
| | | | - Mariamo Mbofana
- Health Programa Nacional de Oftalmologia, Ministerio da Saude, Maputo, Moçambique
| | - Siobhain McCullagh
- Neglected Tropical Diseases Department, Sightsavers, Haywards Heath, United Kingdom
| | - Tom Millar
- Neglected Tropical Diseases Department, Sightsavers, Haywards Heath, United Kingdom
| | | | - Lisa A. Rotondo
- RTI International, Washington, D.C., United States of America
| | - Angela Weaver
- United States Agency for International Development, Washington, D.C., United States of America
| | - Rebecca Willis
- Task Force for Global Health, Atlanta, GA, United States of America
| | - Anthony W. Solomon
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| |
Collapse
|
13
|
Kalua K, Chisambi A, Chinyanya D, Kamwendo Z, Masika M, Willis R, Flueckiger RM, Pavluck AL, Solomon AW. Completion of Baseline Trachoma Mapping in Malawi: Results of Eight Population-Based Prevalence Surveys Conducted with the Global Trachoma Mapping Project. Ophthalmic Epidemiol 2016; 23:32-38. [PMID: 27726469 PMCID: PMC5706967 DOI: 10.1080/09286586.2016.1230224] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: Following a first phase of trachoma mapping in Malawi with the Global Trachoma Mapping Project, we identified and mapped trachoma districts previously suspected to be non-endemic, although adjacent to districts with estimated trachoma prevalences indicating a public health problem. Methods: We conducted population-based surveys in eight evaluation units (EUs) comprising eight districts in Malawi (total population 3,230,272). A 2-stage cluster random sampling design allowed us to select 30 households from each of 30 clusters per EU; all residents aged 1 year and older in selected households were examined for evidence of trachomatous inflammation–follicular (TF) and trachomatous trichiasis (TT). Results: None of the eight EUs had a TF prevalence in 1–9-year-olds ≥10%, one district (Dedza) had a TF prevalence between 5.0% and 9.9%, and only one district (Karonga) had a trichiasis prevalence in adults ≥0.2%. Conclusion: The prevalence of TF and TT in six of eight EUs surveyed was consistent with an original categorization of trachoma being unlikely to be a public health problem. In the absence of formal surveys, health management information system data and other locally available information about trachoma is likely to be useful in predicting areas where public health interventions against trachoma are required.
Collapse
Affiliation(s)
- Khumbo Kalua
- a Department of Ophthalmology , University of Malawi, College of Medicine , Blantyre , Malawi.,b Blantyre Institute for Community Ophthalmology , Lions Sight First Eye Hospital , Blantyre , Malawi
| | - Alvin Chisambi
- b Blantyre Institute for Community Ophthalmology , Lions Sight First Eye Hospital , Blantyre , Malawi
| | - David Chinyanya
- b Blantyre Institute for Community Ophthalmology , Lions Sight First Eye Hospital , Blantyre , Malawi
| | - Zachariah Kamwendo
- b Blantyre Institute for Community Ophthalmology , Lions Sight First Eye Hospital , Blantyre , Malawi
| | | | - Rebecca Willis
- d International Trachoma Initiative , Task Force for Global Health , Decatur , GA , USA
| | - Rebecca M Flueckiger
- e Clinical Research Department , London School of Hygiene & Tropical Medicine , London , UK
| | - Alexandre L Pavluck
- e Clinical Research Department , London School of Hygiene & Tropical Medicine , London , UK
| | - Anthony W Solomon
- e Clinical Research Department , London School of Hygiene & Tropical Medicine , London , UK.,f Department of Control of Neglected Tropical Diseases , World Health Organization , Geneva , Switzerland
| |
Collapse
|