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Fuller BB, Harris V, Parker C, Martinez A, Toubali E, Ebene BC, Asemanyi-Mensah K, Dembele M, Salissou AB, Kabré C, Meite A, Kane NM, Kargbo-Labour I, Batcho W, Diaby A, Yevstigneyeva V, Stukel DM. Contextual determinants of mass drug administration performance: Modelling fourteen years of lymphatic filariasis treatments in West Africa. PLoS Negl Trop Dis 2023; 17:e0011146. [PMID: 36827450 PMCID: PMC9994721 DOI: 10.1371/journal.pntd.0011146] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 03/08/2023] [Accepted: 02/06/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND Effective mass drug administration (MDA) is the cornerstone in the elimination of lymphatic filariasis (LF) and a critical component in combatting all neglected tropical diseases for which preventative chemotherapy is recommended (PC-NTDs). Despite its importance, MDA coverage, however defined, is rarely investigated systematically across time and geography. Most commonly, investigations into coverage react to unsatisfactory outcomes and tend to focus on a single year and health district. Such investigations omit more macro-level influences including sociological, environmental, and programmatic factors. The USAID NTD database contains measures of performance from thousands of district-level LF MDA campaigns across 14 years and 10 West African countries. Specifically, performance was measured as an MDA's epidemiological coverage, calculated as persons treated divided by persons at risk. This analysis aims to explain MDA coverage across time and geography in West Africa using sociological, environmental, and programmatic factors. METHODOLOGY The analysis links epidemiological coverage data from 3,880 LF MDAs with contextual, non-NTD data via location (each MDA was specific to a health district) and time (MDA month, year). Contextual data included rainfall, temperature, violence or social unrest, COVID-19, the 2014 Ebola outbreak, road access/isolation, population density, observance of Ramadan, and the number of previously completed MDAs. PRINCIPAL FINDINGS We fit a hierarchical linear regression model with coverage as the dependent variable and performed sensitivity analyses to confirm the selection of the explanatory factors. Above average rainfall, COVID-19, Ebola, violence and social unrest were all significantly associated with lower coverage. Years of prior experience in a district and above average temperature were significantly associated with higher coverage. CONCLUSIONS/SIGNIFICANCE These generalized and context-focused findings supplement current literature on coverage dynamics and MDA performance. Findings may be used to quantify typically anecdotal considerations in MDA planning. The model and methodology are offered as a tool for further investigation.
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Affiliation(s)
- Brian B. Fuller
- Helen Keller International, Washington, District of Columbia, United States of America
- * E-mail:
| | - Vance Harris
- FHI 360, Denver, Colorado, United States of America
| | - Caleb Parker
- FHI 360, Durham, North Carolina, United States of America
| | | | - Emily Toubali
- Division of Neglected Tropical Diseases, Office of Infectious Diseases, Bureau for Global Health, USAID, Washington, District of Columbia, United States of America
| | - Blandine Clarisse Ebene
- National Programme for Onchocerciasis and Lymphatic Filariasis Control, Ministry of Public Health, Yaoundé, Cameroon
| | - Kofi Asemanyi-Mensah
- Neglected Tropical Diseases Programme, Disease Control and Prevention Department, Ghana Health Service, Public Health Division, Accra, Ghana
| | - Massitan Dembele
- National Programme for the Elimination of LF, Ministry of Health, Bamako, Mali
| | | | - Cathérine Kabré
- Programme national de lutte contre les maladies tropicales négligées, Ministry of Health, Ouagadougou, Burkina Faso
| | - Aboulaye Meite
- Programme national de lutte contre les maladies tropicales négligées à chimiothérapie préventive, Ministry of Health, Abidjan, Côte d’Ivoire
| | - Ndeye Mbacke Kane
- National Neglected Tropical Diseases Control Program, Ministry of Health, Dakar, Senegal
| | - Ibrahim Kargbo-Labour
- Neglected Tropical Disease Programme, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Wilfrid Batcho
- Programme National de Lutte contre les Maladies Transmissibles, Ministry of Health, Cotonou, Benin
| | - Aissatou Diaby
- National Neglected Tropical Diseases Control Program, Ministry of Health, Conakry, Guinea
| | - Violetta Yevstigneyeva
- Division of Neglected Tropical Diseases, Office of Infectious Diseases, Bureau for Global Health, USAID, Washington, District of Columbia, United States of America
| | - Diana Maria Stukel
- Act to End NTDs | West, FHI 360, Washington, District of Columbia, United States of America
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D. Nash S, Chernet A, Weiss P, W. Nute A, Zerihun M, Sata E, Gessese D, A. Jensen K, Ayele Z, Melak B, Zeru T, Mengistu A, Abebe A, Seife F, Tadesse Z, Callahan EK. Prevalence of Ocular Chlamydia trachomatis Infection in Amhara Region, Ethiopia, after 8 Years of Trachoma Control Interventions. Am J Trop Med Hyg 2023; 108:261-267. [PMID: 36623484 PMCID: PMC9896333 DOI: 10.4269/ajtmh.22-0535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 10/14/2022] [Indexed: 01/11/2023] Open
Abstract
Although trachoma mass drug administration (MDA) programs target ocular Chlamydia trachomatis, the global trachoma control program does not monitor infection as a measure of impact but instead relies on monitoring clinical indicators. This study aimed to monitor the prevalence of ocular C. trachomatis among a population-based sample of children ages 1-5 years throughout Amhara, Ethiopia, a region that has received approximately 8 years of annual MDA as part of trachoma control. Between 2014 and 2021, trachoma impact surveys and surveillance surveys were conducted in all 156 districts of Amhara using a multistage cluster randomized methodology. Certified graders assessed individuals ages ≥ 1 year for trachomatous inflammation-follicular (TF), and a random subset of children ages 1-5 years also provided a conjunctival swab. Polymerase chain reaction was used to test for C. trachomatis. A total of 28,410 conjunctival swabs were collected from children ages 1-5 years across Amhara. The regional C. trachomatis infection prevalence was 4.7% (95% uncertainty interval: 4.3-5.1%). Infection was detected in all 10 zones of the region and ranged from 0.2% in Awi Zone to 11.9% in Waghemra Zone. Infection was detected in 17 (26%) districts with a TF prevalence < 10% and in 7 (21%) districts with a TF prevalence < 5%. Through programmatic monitoring of C. trachomatis infection, this study demonstrated that considerable infection remained throughout Amhara despite approximately 8 years of trachoma interventions and that enhanced interventions such as more frequent than annual MDA will be needed if elimination thresholds are to be reached.
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Affiliation(s)
- Scott D. Nash
- Trachoma Control Program, The Carter Center, Atlanta, Georgia;,Address correspondence to Scott Nash, The Carter Center, 453 John Lewis Freedom Pkwy. NE, Atlanta, GA 30307. E-mail:
| | - Ambahun Chernet
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Paul Weiss
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia
| | - Andrew W. Nute
- Trachoma Control Program, The Carter Center, Atlanta, Georgia
| | - Mulat Zerihun
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Eshetu Sata
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Demelash Gessese
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | | | - Zebene Ayele
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Berhanu Melak
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Taye Zeru
- Amhara Public Health Institute, Bahir, Dar, Ethiopia
| | | | - Adisu Abebe
- Amhara Regional Health Bureau, Bahir Dar, Ethiopia
| | | | - Zerihun Tadesse
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
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O'Brien KS, Arzika AM, Maliki R, Amza A, Manzo F, Mankara AK, Lebas E, Cook C, Oldenburg CE, Porco TC, Arnold BF, Bertozzi S, Keenan JD, Lietman TM. Azithromycin distribution and childhood mortality in compliance-related subgroups in Niger: complier average causal effect and spillovers in a cluster-randomized, placebo-controlled trial. Int J Epidemiol 2022; 51:1775-1784. [PMID: 34508582 DOI: 10.1093/ije/dyab198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Biannual azithromycin distribution to children 1-59 months old reduced all-cause mortality by 18% [incidence rate ratio (IRR) 0.82, 95% confidence interval (CI): 0.74, 0.90] in an intention-to-treat analysis of a randomized controlled trial in Niger. Estimation of the effect in compliance-related subgroups can support decision making around implementation of this intervention in programmatic settings. METHODS The cluster-randomized, placebo-controlled design of the original trial enabled unbiased estimation of the effect of azithromycin on mortality rates in two subgroups: (i) treated children (complier average causal effect analysis); and (ii) untreated children (spillover effect analysis), using negative binomial regression. RESULTS In Niger, 594 eligible communities were randomized to biannual azithromycin or placebo distribution and were followed from December 2014 to August 2017, with a mean treatment coverage of 90% [standard deviation (SD) 10%] in both arms. Subgroup analyses included 2581 deaths among treated children and 245 deaths among untreated children. Among treated children, the incidence rate ratio comparing mortality in azithromycin communities to placebo communities was 0.80 (95% CI: 0.72, 0.88), with mortality rates (deaths per 1000 person-years at risk) of 16.6 in azithromycin communities and 20.9 in placebo communities. Among untreated children, the incidence rate ratio was 0.91 (95% CI: 0.69, 1.21), with rates of 33.6 in azithromycin communities and 34.4 in placebo communities. CONCLUSIONS As expected, this analysis suggested similar efficacy among treated children compared with the intention-to-treat analysis. Though the results were consistent with a small spillover benefit to untreated children, this trial was underpowered to detect spillovers.
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Affiliation(s)
- Kieran S O'Brien
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA.,School of Public Health, University of California, Berkeley, CA, USA
| | | | | | - Abdou Amza
- Programme National de Santé Oculaire, Niamey, Niger
| | | | | | - Elodie Lebas
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA
| | - Catherine Cook
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA
| | - Catherine E Oldenburg
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA.,Department of Ophthalmology, University of California, San Francisco, CA, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Travis C Porco
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA.,Department of Ophthalmology, University of California, San Francisco, CA, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.,Institute for Global Health Sciences, University of California, San Francisco, CA, USA
| | - Benjamin F Arnold
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA.,Department of Ophthalmology, University of California, San Francisco, CA, USA
| | - Stefano Bertozzi
- School of Public Health, University of California, Berkeley, CA, USA.,Department of Global Health, University of Washington, Seattle, WA, USA.,Instituto Nacional de Salud Pública, Cuernavaca, MOR, México
| | - Jeremy D Keenan
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA.,Department of Ophthalmology, University of California, San Francisco, CA, USA
| | - Thomas M Lietman
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA.,Department of Ophthalmology, University of California, San Francisco, CA, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.,Institute for Global Health Sciences, University of California, San Francisco, CA, USA
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Gebrezgabiher G, Yewhalaw D, Hailu A, Mekonnen Z. Evaluation of mass treatment with ivermectin program reach and survey coverage for onchocerciasis elimination in selected endemic areas of Ethiopia. PLoS One 2022; 17:e0271518. [PMID: 35901026 PMCID: PMC9333289 DOI: 10.1371/journal.pone.0271518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 07/02/2022] [Indexed: 11/25/2022] Open
Abstract
Currently, national governments of onchocerciasis endemic African countries are working towards the elimination of the disease using mass drug administration (MDA) with ivermectin as a primary strategy. Attainment of this goal requires implementation of prolonged high MDA coverage in all endemic areas, and vigilant monitoring and evaluation of the program. This study was thus conducted with the purpose of i) providing estimate of ivermectin coverage, ii) validating the MDA coverage reported through community drug distributors (CDDs), iii) determining the factors associated with MDA coverage, and iv) estimating the difference between MDA program reach and survey coverage rates following MDA campaign carried out in May 2017 in Asosa and Yeki districts in Ethiopia. A community-based cross-sectional study was conducted among 2,824 study participants in Asosa and Yeki districts. A total of 50 kebeles (smallest administrative units) were randomly selected from the two districts. A systematic sampling was employed to select study households from the 50 kebeles. Then, a household member was randomly selected for the interview. Univariate and multivariate logistic regression analysis were used to determine the odds ratio and to observe the associations between the MDA survey coverage and the variables used. Eighty-seven percent (2458/2824) of the respondents from both districts responded that they were offered ivermectin during the May 2017 MDA campaign. At the district level, 1182 individuals from Yeki and 1276 from Asosa, received the drug, that indicate 88.5% and 85.8% MDA program reach in Yeki and Assosa districts, respectively. Whereas, a total of 366 individuals were not offered ivermectin in both study districts. Of these, 47(12.8%), 143(39.1%), and 176(48.1%) did not receive the drug because of program implementation-related reasons, ineligibility criteria, and personal issues, respectively. Of the 1488 and 1336 respondents in Asosa and Yeki, 1272 and 1182 participants took the drug, resulting in survey coverage rate of 85.5% (95% CI: 83.6–87.2%) and 88.5% (95% CI: 86.7–90.1%), respectively. Multivariable logistic regression analysis revealed significantly low survey coverage rate in females (AOR = 0.5, 95%CI: 0.3–0.6; p<0.001) and in those whose age ranges between 15–24 years (AOR = 0.5, 95%CI: 0.3–0.8; p = 0.007) and 25–34 years (AOR = 0.5, 95%CI: 0.3–0.9; p = 0.021) in Asosa. The researchers believe that the current study generated operational evidence on MDA program reach and coverage rates in two study districts in Ethiopia. The survey coverages were lower than the recommended 90% minimum threshold for success. Only Yeki district reached the 90% threshold survey coverage. Both districts had reported higher coverages than the survey estimates (even outside the 95% CI), thus, were not validated. The majority (60.9%) of the reasons for not receiving the drug were related to program implementation and recipients`personal issues. Efforts must therefore be directed to enhance MDA coverage in future rounds via proper MDA planning and implementation, such as allocating adequate time to the MDA activities, health education, and mobilizing of all segments of the population, including adolescents and the youth. The researchers also recommend such studies to be extended to other MDA programs for other neglected tropical diseases (NTDs).
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Affiliation(s)
- Gebremedhin Gebrezgabiher
- School of Medical Laboratory Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
- College of Veterinary Medicine, Samara University, Samara, Ethiopia
- * E-mail:
| | - Delenasaw Yewhalaw
- School of Medical Laboratory Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
- Tropical and Infectious Diseases Research Center, Jimma University, Jimma, Ethiopia
| | - Asrat Hailu
- Department of Microbiology, Immunology, and Parasitology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Zeleke Mekonnen
- School of Medical Laboratory Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
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To eliminate trachoma: Azithromycin mass drug administration coverage and associated factors among adults in Goro district, Southeast Ethiopia. PLoS Negl Trop Dis 2022; 16:e0010169. [PMID: 35759466 PMCID: PMC9236244 DOI: 10.1371/journal.pntd.0010169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 05/20/2022] [Indexed: 11/30/2022] Open
Abstract
Background Globally, although effective prevention strategies and treatment are available, trachoma remains the major cause of infectious loss of sight. Trachoma is a predominant neglected disease in Ethiopia, and there is a 40.4% prevalence of active trachoma in the Goro district, Southeast Ethiopia. World Health Organization (WHO) recommends azithromycin mass treatment of at least 80% coverage to eliminate trachoma, even though the coverage of azithromycin mass treatment has not been studied yet in depth. Thus, this study aimed to assess the coverage and factors influencing azithromycin mass treatment uptake among adults in Goro district, Southeast Ethiopia. Methods A community-based cross-sectional study was conducted from April 1st to April 30th, 2021 among all adults aged 15 years old and above. The multistage sampling technique was used to select 593 study respondents. A structured interviewer-administered questionnaire was used. Data were entered into Epi-Data version 3.1 and analyzed using SPSS version 23.0 software. Descriptive analysis and binary logistic regression analysis were used to analyze the data. Adjusted odds ratios (AOR) along with a 95% confidence interval (CI) and p-value < 0.05 were used to declare the strength and the significance of association, respectively. Results/Principal findings Five hundred and seventy eight study participants with a 97% response rate were included. The proportion of azithromycin mass drug administration coverage was found to be 75.80%; 95% CI: (72%-79%) in this study. Having better knowledge about trachoma (AOR = 2.36; 95% CI: 1.19–4.70), having better knowledge about azithromycin mass treatment (AOR = 4.19; 95% CI: 2.19–7.98), being educated (AOR = 7.20; 95% CI: 1.02–51.09), a campaign conducted at the quiet time (off-harvesting/planting season) (AOR = 6.23; 95% CI: 3.23–11.98), heard about the serious adverse effect from others (AOR = 0.25; 95% CI: 0.10–0.59) and being a volunteer to take azithromycin in the next campaign (AOR = 5.46; 95% CI: 2.76–10.79) were significantly associated with azithromycin mass drug administration coverage. Conclusions/Significance The proportion of azithromycin mass treatment coverage of this study was lower than the WHO minimum target coverage. Thus, strengthening awareness, enhancing azithromycin mass trachoma treatment messages, and conducting campaigns off-season outside of harvesting and planting time should be prioritized in the future to meet the 2030 Sustainable Development Goal (SDG) target. Trachoma is the leading cause of infectious loss of sight worldwide. The mass treatment with azithromycin has been used in the prevention and treatment of chlamydia trachomatis and is recognized as a potentially vital and important public health strategy for the control of trachoma disease and other co-infections. Oral azithromycin is easy to administer and offers a better resolution for controlling blinding trachoma for long periods. The proportion of azithromycin mass treatment coverage in the Goro district was lower than the WHO minimum target. Having better knowledge about the trachoma and azithromycin mass treatment and being educated were some of the factors positively affecting the uptake of the azithromycin mass treatment. Hearing serious adverse effects of the drug from other people and campaigns conducted during harvesting or seeding time were some factors negatively affecting the coverage of azithromycin mass treatment in the current study.
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Insights from mathematical modelling and quantitative analysis on the proposed 2030 goals for trachoma. Gates Open Res 2021; 3:1721. [PMID: 34027309 PMCID: PMC8111938 DOI: 10.12688/gatesopenres.13086.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2021] [Indexed: 01/21/2023] Open
Abstract
Trachoma is a neglected tropical disease and the leading infectious cause of blindness worldwide. The current World Health Organization goal for trachoma is elimination as a public health problem, defined as reaching a prevalence of trachomatous inflammation-follicular below 5% in children (1-9 years) and a prevalence of trachomatous trichiasis in adults below 0.2%. Current targets to achieve elimination were set to 2020 but are being extended to 2030. Mathematical and statistical models suggest that 2030 is a realistic timeline for elimination as a public health problem in most trachoma endemic areas. Although the goal can be achieved, it is important to develop appropriate monitoring tools for surveillance after having achieved the elimination target to check for the possibility of resurgence. For this purpose, a standardized serological approach or the use of multiple diagnostics in complement would likely be required.
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7
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Insights from mathematical modelling and quantitative analysis on the proposed 2030 goals for trachoma. Gates Open Res 2021; 3:1721. [PMID: 34027309 DOI: 10.12688/gatesopenres.13086.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2019] [Indexed: 11/20/2022] Open
Abstract
Trachoma is a neglected tropical disease and the leading infectious cause of blindness worldwide. The current World Health Organization goal for trachoma is elimination as a public health problem, defined as reaching a prevalence of trachomatous inflammation-follicular below 5% in children (1-9 years) and a prevalence of trachomatous trichiasis in adults below 0.2%. Current targets to achieve elimination were set to 2020 but are being extended to 2030. Mathematical and statistical models suggest that 2030 is a realistic timeline for elimination as a public health problem in most trachoma endemic areas. Although the goal can be achieved, it is important to develop appropriate monitoring tools for surveillance after having achieved the elimination target to check for the possibility of resurgence. For this purpose, a standardized serological approach or the use of multiple diagnostics in complement would likely be required.
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8
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Nash SD, Astale T, Nute AW, Bethea D, Chernet A, Sata E, Zerihun M, Gessese D, Ayenew G, Ayele Z, Melak B, Haile M, Zeru T, Tadesse Z, Arnold BF, Callahan EK, Martin DL. Population-Based Prevalence of Chlamydia trachomatis Infection and Antibodies in Four Districts with Varying Levels of Trachoma Endemicity in Amhara, Ethiopia. Am J Trop Med Hyg 2021; 104:207-215. [PMID: 33200728 PMCID: PMC7790060 DOI: 10.4269/ajtmh.20-0777] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
The Trachoma Control Program in Amhara region, Ethiopia, scaled up the surgery, antibiotics, facial cleanliness, and environmental improvement (SAFE) strategy in all districts starting in 2007. Despite these efforts, many districts still require additional years of SAFE. In 2017, four districts were selected for the assessment of antibody responses against Chlamydia trachomatis antigens and C. trachomatis infection to better understand transmission. Districts with differing endemicity were chosen, whereby one had a previous trachomatous inflammation-follicular (TF) prevalence of ≥ 30% (Andabet), one had a prevalence between 10% and 29.9% (Dera), one had a prevalence between 5% and 10% (Woreta town), and one had a previous TF prevalence of < 5% (Alefa) and had not received antibiotic intervention for 2 years. Survey teams assessed trachoma clinical signs and took conjunctival swabs and dried blood spots (DBS) to measure infection and antibody responses. Trachomatous inflammation-follicular prevalence among children aged 1–9 years was 37.0% (95% CI: 31.1–43.3) for Andabet, 14.7% (95% CI: 10.0–20.5) for Dera, and < 5% for Woreta town and Alefa. Chlamydia trachomatis infection was only detected in Andabet (11.3%). Within these districts, 2,195 children provided DBS. The prevalence of antibody responses to the antigen Pgp3 was 36.9% (95% CI: 29.0–45.6%) for Andabet, 11.3% (95% CI: 5.9–20.6%) for Dera, and < 5% for Woreta town and Alefa. Seroconversion rate for Pgp3 in Andabet was 0.094 (95% CI: 0.069–0.128) events per year. In Andabet district, where SAFE implementation has occurred for 11 years, the antibody data support the finding of persistently high levels of trachoma transmission.
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Affiliation(s)
- Scott D Nash
- 1Trachoma Control Program, The Carter Center, Atlanta, Georgia
| | - Tigist Astale
- 2Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Andrew W Nute
- 1Trachoma Control Program, The Carter Center, Atlanta, Georgia
| | - Danaya Bethea
- 3Centers for Disease Control and Prevention, DPD, Atlanta, Georgia
| | - Ambahun Chernet
- 2Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Eshetu Sata
- 2Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Mulat Zerihun
- 2Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Demelash Gessese
- 2Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Gedefaw Ayenew
- 2Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Zebene Ayele
- 2Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Berhanu Melak
- 2Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Mahteme Haile
- 4Amhara Public Health Institute, Research and Technology Transfer Directorate, Bahir Dar, Ethiopia
| | - Taye Zeru
- 4Amhara Public Health Institute, Research and Technology Transfer Directorate, Bahir Dar, Ethiopia
| | - Zerihun Tadesse
- 2Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Benjamin F Arnold
- 5Francis I. Proctor Foundation, University of California San Francisco, San Francisco, California.,6Department of Ophthalmology, University of California San Francisco, San Francisco, California
| | | | - Diana L Martin
- 3Centers for Disease Control and Prevention, DPD, Atlanta, Georgia
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Sata E, Nute AW, Astale T, Gessese D, Ayele Z, Zerihun M, Chernet A, Melak B, Jensen KA, Haile M, Zeru T, Beyen M, Dawed AA, Seife F, Tadesse Z, Callahan EK, Ngondi J, Nash SD. Twelve-Year Longitudinal Trends in Trachoma Prevalence among Children Aged 1-9 years in Amhara, Ethiopia, 2007-2019. Am J Trop Med Hyg 2021; 104:1278-1289. [PMID: 33534757 PMCID: PMC8045658 DOI: 10.4269/ajtmh.20-1365] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 11/23/2020] [Indexed: 11/07/2022] Open
Abstract
Trachoma control in the Amhara region of Ethiopia, where all districts were once endemic, began in 2001 and attained full scale-up of the Surgery, Antibiotics, Facial cleanliness, and Environmental improvement (SAFE) strategy by 2010. Since scaling up, the program has distributed approximately 14 million doses of antibiotic per year, implemented village- and school-based health education, and promoted latrine construction. This report aims to provide an update on the prevalence of trachoma among children aged 1-9 years as of the most recent impact or surveillance survey in all 160 districts of Amhara. As of 2019, 45 (28%) districts had a trachomatous inflammation-follicular (TF) prevalence below the 5% elimination threshold. There was a statistically significant relationship between TF prevalence observed at the first impact survey (2010-2015) and eventual achievement of TF < 5% (2015-2019). Of the 26 districts with a first impact survey < 10% TF, 20 (76.9%) had < 5% TF at the most recent survey. Of the 75 districts with a first survey between 10% and 29.9% TF, 21 (28.0%) had < 5% TF at the most recent survey. Finally, among 59 districts ≥ 30% TF at the first survey, four (6.8%) had < 5% TF by 2019. As of 2019, 30 (18.8%) districts remained with TF ≥ 30%. Amhara has seen considerable reductions of trachoma since the start of the program. A strong commitment to the SAFE strategy coupled with data-driven enhancements to that strategy is necessary to facilitate timely elimination of trachoma as a public health problem regionally in Amhara and nationwide in Ethiopia.
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Affiliation(s)
- Eshetu Sata
- 1Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Andrew W Nute
- 2Trachoma Control Program, The Carter Center, Atlanta, Georgia
| | - Tigist Astale
- 1Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Demelash Gessese
- 1Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Zebene Ayele
- 1Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Mulat Zerihun
- 1Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Ambahun Chernet
- 1Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Berhanu Melak
- 1Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | | | - Mahteme Haile
- 3Amhara Public Health Institute, Research and Technology Transfer Directorate, Bahir Dar, Ethiopia
| | - Taye Zeru
- 3Amhara Public Health Institute, Research and Technology Transfer Directorate, Bahir Dar, Ethiopia
| | - Melkamu Beyen
- 4Amhara Regional Health Bureau, Health Promotion and Disease Prevention, Bahir Dar, Ethiopia
| | - Adisu Abebe Dawed
- 4Amhara Regional Health Bureau, Health Promotion and Disease Prevention, Bahir Dar, Ethiopia
| | - Fikre Seife
- 5Federal Ministry of Health, Disease Prevention and Control Directorate, Addis Ababa, Ethiopia
| | - Zerihun Tadesse
- 1Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | | | - Jeremiah Ngondi
- 6RTI International, International Development (Global Health), London, United Kingdom
| | - Scott D Nash
- 2Trachoma Control Program, The Carter Center, Atlanta, Georgia
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10
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Pickering H, Chernet A, Sata E, Zerihun M, Williams CA, Breuer J, Nute AW, Haile M, Zeru T, Tadesse Z, Bailey RL, Callahan EK, Holland MJ, Nash SD. Genomics of Ocular Chlamydia trachomatis after 5 years of SAFE interventions for trachoma in Amhara, Ethiopia. J Infect Dis 2020; 225:994-1004. [PMID: 33034349 PMCID: PMC8922003 DOI: 10.1093/infdis/jiaa615] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 09/30/2020] [Indexed: 12/18/2022] Open
Abstract
To eliminate trachoma as a public health problem, the WHO recommends the SAFE (Surgery, Antibiotics, Facial cleanliness, and Environmental improvement) strategy. As part of the SAFE strategy in the Amhara Region, Ethiopia, the Trachoma Control Program distributed over 124 million doses of antibiotic between 2007 and 2015. Despite this, trachoma remained hyperendemic in many districts and a considerable level of Chlamydia trachomatis (Ct) infection was evident. We utilised residual material from Abbott m2000 Ct diagnostic tests to sequence 99 ocular Ct samples from Amhara and investigated the role of Ct genomic variation in continued transmission of Ct. Sequences were typical of ocular Ct, at the whole-genome level and in tissue tropism-associated genes. There was no evidence of macrolide-resistance in this population. Polymorphism around ompA gene was associated with village-level trachomatous inflammation-follicular prevalence. Greater ompA diversity at the district-level was associated with increased Ct infection prevalence. We found no evidence for Ct genomic variation contributing to continued transmission of Ct after treatment, adding to evidence that azithromycin does not drive acquisition of macrolide resistance in Ct. Increased Ct infection in areas with more ompA variants requires longitudinal investigation to understand what impact this may have on treatment success and host immunity.
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Affiliation(s)
- Harry Pickering
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, UK
| | | | | | | | | | - Judith Breuer
- Division of Infection and Immunity, University College London, UK
| | | | | | - Taye Zeru
- Amhara Public Health Institute Bahir Dar, Ethiopia
| | | | - Robin L Bailey
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, UK
| | | | - Martin J Holland
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, UK
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11
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Knowledge, Attitudes, and Practices about Trachoma in Rural Communities of Tigray Region, Northern Ethiopia: Implications for Prevention and Control. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2020; 2020:3270530. [PMID: 32774392 PMCID: PMC7397421 DOI: 10.1155/2020/3270530] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 06/04/2020] [Accepted: 06/22/2020] [Indexed: 12/03/2022]
Abstract
Background Trachoma is a neglected tropical disease which is the leading infectious cause of blindness in the world. Trachoma is one of the major health problems in Tigray Region, Northern Ethiopia. However, knowledge, attitudes, and practices about trachoma are not yet studied in depth. The objective of the study was to assess knowledge, attitudes, and practices on trachoma and its associated factors among rural communities in two districts of Tigay Region, Northern Ethiopia. Methods A cross-sectional study was conducted in two districts of Tigray Region, Northern Ethiopia, from May 7–24, 2017. Data were collected on paper based, were entered into Epi Info version 3.5.1, and then exported to SPSS version 21 for analysis. Logistic regression analysis was done to identify factors associated with knowledge, attitudes, and practices. Results In this study, a total of 194 respondents were included. The overall level of good knowledge, attitudes, and practices on trachoma was 51%, 49.5%, and 35.6%, respectively. Having ever received health education was significantly associated with good knowledge (adjusted odds ratio (AOR) = 4.10; 95% confidence interval (CI): 1.91–8.79) and attitudes (AOR = 2.10; 95% CI: 1.02–4.25). Moreover, good knowledge was associated with good practices on trachoma prevention and control (AOR = 2.86; 95% CI: 1.46–5.62). Conclusion Our study implies that areas with high burden of trachoma need to improve communities' knowledge, attitudes, and practices towards trachoma prevention and control in order to eliminate trachoma as a public health problem. Therefore, health education focused on SAFE strategy should be provided to increase knowledge and changing attitudes that contribute for good practices towards trachoma prevention and control among communities.
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12
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Nash SD, Chernet A, Moncada J, Stewart AEP, Astale T, Sata E, Zerihun M, Gessese D, Melak B, Ayenew G, Ayele Z, Chanyalew M, Lietman TM, Callahan EK, Schachter J, Tadesse Z. Ocular Chlamydia trachomatis infection and infectious load among pre-school aged children within trachoma hyperendemic districts receiving the SAFE strategy, Amhara region, Ethiopia. PLoS Negl Trop Dis 2020; 14:e0008226. [PMID: 32421719 PMCID: PMC7259799 DOI: 10.1371/journal.pntd.0008226] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 05/29/2020] [Accepted: 03/17/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND After approximately 5 years of SAFE (surgery, antibiotics, facial cleanliness, environmental improvement) interventions for trachoma, hyperendemic (trachomatous inflammation-follicular (TF) ≥30%) districts remained in Amhara, Ethiopia. This study's aim was to characterize the epidemiology of Chlamydia trachomatis (Ct) infection and load among pre-school aged children living under the SAFE strategy. METHODS Conjunctival swabs from a population-based sample of children aged 1-5 years collected between 2011 and 2015 were assayed to provide Ct infection data from 4 endemic zones (comprised of 58 districts). Ct load was determined using a calibration curve. Children were graded for TF and trachomatous inflammation-intense (TI). RESULTS 7,441 children were swabbed in 4 zones. TF and TI prevalence were 39.9% (95% confidence Interval [CI]: 37.5%, 42.4%), and 9.2% (95% CI: 8.1%, 10.3%) respectively. Ct infection prevalence was 6.0% (95% CI: 5.0%, 7.2%). Infection was highest among children aged 2 to 4 years (6.6%-7.0%). Approximately 10% of infection occurred among children aged 1 year. Ct load decreased with age (P = 0.002), with the highest loads observed in children aged 1 year (P = 0.01) vs. aged 5 years. Participants with TF (P = 0.20) and TI (P<0.01) had loads greater than individuals without active trachoma. CONCLUSIONS In this hyperendemic setting, it appears that the youngest children may contribute in meaningful ways towards persistent active trachoma.
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Affiliation(s)
- Scott D. Nash
- Trachoma Control Program, The Carter Center, Atlanta, United States of America
| | - Ambahun Chernet
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Jeanne Moncada
- Department of Laboratory Medicine, University of California, San Francisco, United States of America
| | - Aisha E. P. Stewart
- Trachoma Control Program, The Carter Center, Atlanta, United States of America
| | - Tigist Astale
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Eshetu Sata
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Mulat Zerihun
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Demelash Gessese
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Berhanu Melak
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Gedefaw Ayenew
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Zebene Ayele
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Melsew Chanyalew
- Health Promotion and Disease Prevention Core Process, Amhara Regional Health Bureau, Bahir Dar, Ethiopia
| | - Thomas M. Lietman
- Francis I. Proctor Foundation, University of California, San Francisco, United States of America
| | - E. Kelly Callahan
- Trachoma Control Program, The Carter Center, Atlanta, United States of America
| | - Julius Schachter
- Department of Laboratory Medicine, University of California, San Francisco, United States of America
| | - Zerihun Tadesse
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
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