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Alada JJ, Mpyet C, Florea VV, Boisson S, Willis R, Bakhtiari A, Muhammad N, Adamu MD, Umar MM, Olobio N, Isiyaku S, Adamani W, Amdife D, Solomon AW. Prevalence of Trachoma in Kogi State, Nigeria: Results of four Local Government Area-Level Surveys from the Global Trachoma Mapping Project. Ophthalmic Epidemiol 2019; 25:33-40. [PMID: 30806551 PMCID: PMC6444201 DOI: 10.1080/09286586.2017.1409359] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE To determine the prevalence of trachoma in four Local Government Areas (LGAs) of Kogi State, Nigeria. METHODS In June 2014, we conducted population-based, cross-sectional surveys according to Global Trachoma Mapping Project (GTMP) protocols in selected LGAs of Kogi State. In each LGA, 25 clusters were selected with probability proportional to size. In each of these clusters, 25 households were enrolled for the survey. All residents of selected households aged ≥1 year were examined by GTMP-certified graders for trachomatous inflammation-follicular (TF) and trichiasis using the simplified trachoma grading scheme. Data on sources of household water and types of sanitation facilities were collected through questioning and direct observation. RESULTS The age-adjusted TF prevalence in 1-9-year-olds ranged from 0.4% (95% CI 0.1-0.8%) in Bassa to 1.0% (95% CI 0.3-1.9%) in Omala. Across all four LGAs, only one case of trichiasis was found; this individual was in Omala, giving that LGA a trichiasis prevalence in individuals aged ≥15 years of 0.02% (95% CI 0.00-0.07%). Between 77 and 88% of households had access to water for hygiene purposes, while only 10-30% had access to improved sanitation facilities. CONCLUSION Trachoma is not a public health problem in any of the 4 LGAs surveyed. There is, however, the need to increase access to adequate water and sanitation services to contribute to the health and social and economic well-being of these communities.
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Affiliation(s)
- Joel J Alada
- a Department of Ophthalmology , Federal Medical Centre , Makurdi , Nigeria
| | - Caleb Mpyet
- b Department of Ophthalmology , University of Jos , Jos , Nigeria.,c Sightsavers , Kaduna , Nigeria.,d Kilimanjaro Centre for Community Ophthalmology International, Division of Ophthalmology , University of Cape Town , Cape Town , South Africa
| | - Victor V Florea
- e Department of Control of Neglected Tropical Diseases , World Health Organization , Geneva , Switzerland
| | - Sophie Boisson
- f Department of Public Health, the Environment and Social Determinants of Health , World Health Organization , Geneva , Switzerland
| | - Rebecca Willis
- g International Trachoma Initiative, Task Force for Global Health , Decatur , GA , USA
| | - Ana Bakhtiari
- g International Trachoma Initiative, Task Force for Global Health , Decatur , GA , USA
| | - Nasiru Muhammad
- h Ophthalmology Unit, Surgery Department , Usmanu Danfodiyo University , Sokoto , Nigeria
| | - Mohammed D Adamu
- h Ophthalmology Unit, Surgery Department , Usmanu Danfodiyo University , Sokoto , Nigeria
| | | | | | | | | | | | - Anthony W Solomon
- e Department of Control of Neglected Tropical Diseases , World Health Organization , Geneva , Switzerland.,l Clinical Research Department , London School of Hygiene & Tropical Medicine , London , United Kingdom.,m London Centre for Neglected Tropical Disease Research , London , United Kingdom
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Alada JJ, Mpyet C, Florea VV, Boisson S, Willis R, Muhammad N, Bakhtiari A, Adamu MD, Pavluck AL, Umar MM, Isiyaku S, William A, Oyinloye FOP, Olobio N, Solomon AW. Prevalence of and risk factors for trachoma in Kwara state, Nigeria: Results of eight population-based surveys from the Global Trachoma Mapping Project. Ophthalmic Epidemiol 2019; 25:53-61. [PMID: 30806548 PMCID: PMC6444274 DOI: 10.1080/09286586.2018.1437188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Purpose: To determine the prevalence of and risk factors for trachoma in selected local government areas (LGAs) of Kwara State, Nigeria. Methodology: Population-based cross-sectional surveys were conducted in eight LGAs of Kwara State using Global Trachoma Mapping Project (GTMP) protocols. In each LGA, 25 villages were selected using probability-proportional-to-size sampling; 25 households were selected from each village using compact segment sampling. All residents of selected households aged ≥1 year were examined by GTMP-certified graders for trachomatous inflammation—follicular (TF) and trichiasis using the simplified trachoma grading scheme. Water, sanitation, and hygiene (WASH) data were also collected. Results: A total of 28,506 residents were enumerated in 4769 households across the eight LGAs. TF prevalence in children aged 1–9 years ranged from 0.2% (95% CI 0.0–0.3%) to 1.3% (95% CI 0.7–2.1%), while trichiasis prevalence in persons ≥15 years was <0.2% in each LGA. Access to improved water source was the lowest in Edu (62%), while access to improved sanitation facilities was the lowest in Asa (6%) and the highest in Ilorin East (64%). Children aged 1–4 years had 0.63 (95% CI 0.40–0.99) times lower odds of having TF compared to children aged 5–9 years. Children in households with ≥5 resident 1–9-year-old children had 1.63 (95% CI 1.02–2.60) times greater odds of having TF compared to those in households with <5 resident children. Conclusion: Trachoma is not a public health problem in Kwara State. Provision of adequate water and sanitation services should be a priority here, as a foundation for the health of the population.
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Affiliation(s)
- Joel J Alada
- a Department of Ophthalmology , Federal Medical Centre , Makurdi , Nigeria
| | - Caleb Mpyet
- b Department of Ophthalmology , University of Jos , Jos , Nigeria.,c Sightsavers , Kaduna , Nigeria.,d Kilimanjaro Centre for Community Ophthalmology International, Division of Ophthalmology , University of Cape Town , Cape Town , South Africa
| | - Victor V Florea
- e Department of Control of Neglected Tropical Diseases , World Health Organization , Geneva , Switzerland
| | - Sophie Boisson
- f Department of Public Health, Environmental and Social Determinants of Health , World Health Organization , Geneva , Switzerland
| | | | - Nasiru Muhammad
- h Ophthalmology Unit, Surgery Department , Usmanu Danfodiyo University , Sokoto , Nigeria
| | | | - Mohammed D Adamu
- h Ophthalmology Unit, Surgery Department , Usmanu Danfodiyo University , Sokoto , Nigeria
| | | | | | | | | | | | | | - Anthony W Solomon
- e Department of Control of Neglected Tropical Diseases , World Health Organization , Geneva , Switzerland.,l Clinical Research Department , London School of Hygiene & Tropical Medicine , London , United Kingdom.,m London Centre for Neglected Tropical Disease Research , London , United Kingdom
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Duale AB, Negussu Ayele N, Macleod CK, Kello AB, Eshetu Gezachew Z, Binegdie A, Dejene M, Alemayehu W, Flueckiger RM, Massae PA, Willis R, Kebede Negash B, Solomon AW. Epidemiology of trachoma and its implications for implementing the "SAFE" strategy in Somali Region, Ethiopia: results of 14 population-based prevalence surveys. Ophthalmic Epidemiol 2019; 25:25-32. [PMID: 30806549 PMCID: PMC6444207 DOI: 10.1080/09286586.2017.1409358] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Purpose: Ethiopia is highly trachoma endemic. Baseline mapping was needed in Ethiopia’s Somali Region to guide elimination efforts. Methods: Cross-sectional community-based surveys were conducted in 34 suspected trachoma-endemic woredas, grouped as 14 evaluation units (EUs), using a standardised mapping methodology developed for the Global Trachoma Mapping Project. Results: In total, 53,467 individuals were enumerated. A total of 48,058 (89.9%) were present at the time of survey teams’ visits and consented to examination. The prevalence of trachomatous inflammation–follicular (TF) among children aged 1–9 years ranged from 4.1% in the EU covering Danot, Boh, and Geladin woredas in Doolo Subzone to 38.1% in the EU covering Kebribeyah and Hareshen woredas in Fafan Subzone (East). The trichiasis prevalence among adults aged over 15 years varied from 0.1% in the EU covering Afder, Bare, and Dolobay woredas in Afder Subzone (West) to 1.2% in the EU covering Awbere in Fafan Subzone (West). Conclusion: Mass drug administration (MDA) with azithromycin is needed in 13 EUs (population 2,845,818). Two EUs (population 667,599) had TF prevalences in 1–9-year-olds of ≥30% and will require at least 5 years of MDA; 5 EUs (population 1,1193,032) had TF prevalences of 10–29.9% and need at least three years of MDA; 6 EUs (population 985,187) had TF prevalences of 5–9.9% and need at least one round of azithromycin distribution before re-survey. In all 13 of these EUs, implementation of facial cleanliness and environmental improvement measures is also needed. Surveys are still needed in the remaining 34 unmapped woredas of Somali Region.
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Affiliation(s)
- Ahmed Badei Duale
- a Department of Disease Prevention , Somali Regional State Health Bureau , Jigjiga , Ethiopia
| | - Nebiyu Negussu Ayele
- a Department of Disease Prevention , Somali Regional State Health Bureau , Jigjiga , Ethiopia
| | - Colin K Macleod
- b Sightsavers , Haywards Heath , UK.,c Clinical Research Department , London School of Hygiene & Tropical Medicine , London , UK
| | | | | | - Amsalu Binegdie
- f Department of Ophthalmology , Gode Hospital , Gode , Ethiopia
| | - Michael Dejene
- g Michael Dejene Public Health Consultancy Services , Addis Ababa , Ethiopia
| | | | | | - Patrick A Massae
- j Kilimanjaro Centre for Community Ophthalmology , Moshi , Tanzania
| | | | | | - Anthony W Solomon
- c Clinical Research Department , London School of Hygiene & Tropical Medicine , London , UK
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Mpyet C, Tagoh S, Boisson S, Willis R, Muhammad N, Bakhtiari A, Adamu MD, Pavluck AL, Umar MM, Alada J, Isiyaku S, Adamani W, Jande B, Olobio N, Solomon AW. Prevalence of Trachoma and Access to Water and Sanitation in Benue State, Nigeria: Results of 23 Population-Based Prevalence Surveys. Ophthalmic Epidemiol 2019; 25:79-85. [PMID: 30806545 PMCID: PMC6444203 DOI: 10.1080/09286586.2018.1467466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Purpose: We sought to determine the prevalence of trachoma in each local government area (LGA) of Benue State, Nigeria. Methods: Two-stage cluster sampling was used to conduct a series of 23 population-based prevalence surveys. LGAs were the evaluation units surveyed. In each LGA, 25 households were selected in each of 25 clusters, and individuals aged 1 year and above resident in those households were invited to be examined for trachoma. Data on access to water and sanitation were also collected at household level. Results: A total of 91,888 people were examined from among 93,636 registered residents across the 23 LGAs. The LGA-level prevalence of trachomatous inflammation—follicular (TF) in 1–9 year olds ranged from 0.3% to 5.3%. Two LGAs had TF prevalences of 5.0–9.9%. The LGA-level prevalence of trichiasis in ≥15-year-olds ranged from 0.0% to 0.35%. Access to improved drinking water sources ranged from 0% in Gwer West to 99% in Tarka, while access to improved sanitation ranged from 1% in Gwer West to 92% in Oturkpo. Conclusion: There is a need for public health-level interventions against trachoma in three LGAs of Benue State.
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Affiliation(s)
- Caleb Mpyet
- a Department of Ophthalmology , University of Jos , Jos , Nigeria.,b Sightsavers , Kaduna , Nigeria.,c Kilimanjaro Centre for Community Ophthalmology International, Division of Ophthalmology , University of Cape Town , Cape Town , South Africa
| | - Selassie Tagoh
- d School of Public Health and Family Medicine , University of Cape Town , Cape Town , South Africa
| | - Sophie Boisson
- e Department of Public He\alth, The Environment and Social Determinants of Health , World Health Organization , Geneva , Switzerland
| | | | - Nasiru Muhammad
- g Ophthalmology Unit, Surgery Department , Usmanu Danfodiyo University , Sokoto , Nigeria
| | | | - Mohammed D Adamu
- g Ophthalmology Unit, Surgery Department , Usmanu Danfodiyo University , Sokoto , Nigeria
| | | | | | - Joel Alada
- i Department of Ophthalmology , Federal Medical Centre , Makurdi , Nigeria
| | | | | | - Betty Jande
- j Ministry of Health , Benue State , Makurdi , Nigeria
| | | | - Anthony W Solomon
- l Clinical Research Department , London School of Hygiene & Tropical Medicine , London , United Kingdom.,m London Centre for Neglected Tropical Disease Research , London , United Kingdom.,n Department of Control of Neglected Tropical Diseases , World Health Organization , Geneva , Switzerland
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- m London Centre for Neglected Tropical Disease Research , London , United Kingdom
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Muhammad N, Mpyet C, Adamu MD, William A, Umar MM, Muazu H, Onyebuchi U, Isiyaku S, Flueckiger RM, Chu BK, Willis R, Pavluck A, Dalhatu A, Ogoshi C, Olobio N, Gordon BA, Solomon AW, For The Global Trachoma Mapping Project. Prevalence of trachoma in the area councils of the Federal Capital Territory, Nigeria: results of six population-based surveys. Ophthalmic Epidemiol 2019; 25:11-17. [PMID: 30806532 PMCID: PMC6444205 DOI: 10.1080/09286586.2017.1367409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Purpose: The World Health Organization’s (WHO’s) global trachoma elimination programme recommends mapping of trachoma at district level for planning of elimination activities in affected populations. This study aimed to provide data on trachoma prevalence for the Area Councils of Nigeria’s Federal Capital Territory (FCT). Methods: Using the Global Trachoma Mapping Project (GTMP) protocols, in March and April 2014, we conducted a population-based cross-sectional survey in each of the six Area Councils of FCT. Signs were defined based on the WHO simplified grading scheme. Results: 98% to 100% of the targeted households were enrolled in each Area Council. The number of children aged 1–9 years examined per Area Council ranged from 867 to 1248. The number of persons aged ≥15 years examined ranged from 1302 to 1836. The age-adjusted prevalence of trachomatous inflammation—follicular in 1–9-year-olds was <5% in each Area Council. The age- and gender-adjusted prevalence of trichiasis in those aged ≥15 years ranged from 0.0% to 0.3%; two Area Councils (Gwagwalada and Kwali) had prevalences above the 0.2% elimination threshold. The proportion of households with access to improved latrines and water sources ranged from 17 to 90% and 39 to 85% respectively. Conclusions: Gwagwalada and Kwali Area Councils need to perform more trichiasis surgeries to attain the trichiasis elimination prevalence target of 0.2% in persons aged ≥15 years. No Area Council requires mass antibiotic administration for the purposes of trachoma’s elimination as a public health problem. All Area Councils need to accelerate provision of access to improved water sources and latrine facilities, to achieve universal coverage.
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Affiliation(s)
- Nasiru Muhammad
- a Ophthalmology Unit, Surgery Department , Usmanu Danfodiyo University , Sokoto , Nigeria
| | - Caleb Mpyet
- b Ophthalmology Department , University of Jos , Jos , Nigeria.,c Sightsavers , Kaduna , Nigeria.,d Kilimanjaro Centre for Community Ophthalmology International, Division of Ophthalmology , University of Cape Town , Cape Town , South Africa
| | - Mohammed Dantani Adamu
- a Ophthalmology Unit, Surgery Department , Usmanu Danfodiyo University , Sokoto , Nigeria
| | - Adamani William
- b Ophthalmology Department , University of Jos , Jos , Nigeria
| | | | | | | | - Sunday Isiyaku
- b Ophthalmology Department , University of Jos , Jos , Nigeria
| | | | - Brian K Chu
- h Task Force for Global Health , Decatur , GA , USA
| | | | - Alex Pavluck
- h Task Force for Global Health , Decatur , GA , USA
| | - Abbas Dalhatu
- i Federal Capital Territory Health Services , Abuja , Nigeria
| | - Chris Ogoshi
- n Health and Development Support Programme , Jos , Nigeria
| | | | - Bruce A Gordon
- j Department of Public Health, Environmental and Social Determinants , World Health Organization , Geneva , Switzerland
| | - Anthony W Solomon
- k Clinical Research Department , London School of Hygiene & Tropical Medicine , London , United Kingdom.,l London Centre for Neglected Tropical Disease Research , London , United Kingdom.,m Department of Control of Neglected Tropical Diseases , World Health Organization , Geneva , Switzerland
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Hoffman JJ, Habtamu E, Rono H, Tadesse Z, Wondie T, Minas T, Gashaw B, Callahan EK, MacLeod D, Burton MJ. 3D images as a field grader training tool for trachomatous trichiasis: A diagnostic accuracy study in Ethiopia. PLoS Negl Trop Dis 2019; 13:e0007104. [PMID: 30677024 PMCID: PMC6363231 DOI: 10.1371/journal.pntd.0007104] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 02/05/2019] [Accepted: 12/20/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Trachomatous trichiasis (TT) will continue to develop among those people who have had repeated infections after active trachoma is controlled. Detecting and treating affected individuals will remain necessary for years; a long "tail" of incident cases is anticipated. As the prevalence of TT declines, there will be fewer cases available for training trachoma graders (TG), necessitating alternative methods. METHODOLOGY/PRINCIPAL FINDINGS Prospective, diagnostic accuracy study assessing sensitivity and specificity of 3D and 2D photography as a tool for training TG to detect TT. Individuals with TT in Ethiopia were examined, and 2D and 3D clinical images taken. Images were independently graded by four graders for presence or absence of trichiasis and compared to field grading. We recruited 153 participants. Clinical assessments and images were available for 306 eyes. Trichiasis was identified in 204 eyes by field grading. Image grading was performed on a selection of 262 eyes (131 with trichiasis). Most eyes with trichiasis had minor trichiasis (94/131). Pooled sensitivity was 88.3% (3D) and 98.0% (2D); pooled specificity was 59.8% (3D) and 26.8% (2D). 3D photo grading was 33.0% more specific than the 2D photo grading (p = 0.0002). The overall Kappa scores were 0.48 (3D) and 0.25 (2D). We trained 26 novice TG in Ethiopia using 3D images. They were tested on a 3D images set and had 71.4% agreement (kappa 0.46), relative to an expert. They were then tested examining 50 people, and had 86.8% agreement (kappa 0.75). We also tested 27 experienced TG on the same cases (86.4% agreement, kappa 0.75). There was no difference in performance between groups (p = 0.76). All participants preferred 3D over 2D images for training. CONCLUSIONS/SIGNIFICANCE The slightly higher sensitivity of 2D photos comes at considerable cost in specificity. Training with 3D images enabled novice TG to identify cases as well as experienced TG. 3D were preferred to conventional 2D photos for training. Standardized 3D images of TT could be a useful tool for training TG, in settings where there are now few TT cases.
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Affiliation(s)
- Jeremy J. Hoffman
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom
| | - Esmael Habtamu
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Hillary Rono
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Ophthalmology Department, Kitale District Hospital, Kitale, Kenya
| | | | | | | | | | | | - David MacLeod
- Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Matthew J. Burton
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom
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Mpyet C, Muhammad N, Adamu MD, Umar MM, Tafida A, Ogoshi C, Maidaura A, Isiyaku S, William A, Willis R, Bakhtiari A, Olobio N, Solomon AW, for the Global Trachoma Mapping Project. Prevalence of Trachoma in Four Local Government Areas of Jigawa State, Nigeria. Ophthalmic Epidemiol 2018; 25:86-92. [PMID: 30806552 PMCID: PMC6444196 DOI: 10.1080/09286586.2018.1467468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 03/17/2018] [Accepted: 04/13/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE To determine the prevalence of trachoma and water and sanitation coverage in four local government areas (LGAs) of Jigawa State, Nigeria: Birnin Kudu, Buji, Dutse and Kiyawa. METHODOLOGY A population-based cross-sectional survey was conducted in each LGA using Global Trachoma Mapping Project (GTMP) protocols. From each LGA, 25 villages were selected using probability-proportional-to-population size sampling; in each village, 25 households were selected using the random walk technique. All residents aged ≥1 year in selected households were examined by GTMP-certified graders for trachomatous inflammation - follicular (TF) and trichiasis, defined according to the WHO simplified trachoma grading scheme definitions. Water, sanitation and hygiene data were also collected through questioning and direct observation. RESULTS In 2458 households of four LGAs, 10,669 residents were enumerated. A total of 9779 people (92% of residents) were examined, with slightly more females examined (5012; 51%) than men. In children aged 1-9 years, the age-adjusted prevalence of TF ranged from 5.1% (95% CI 2.5-9.0%) in Birnin Kudu to 12.8% (95% CI 7.6-19.4%) in Kiyawa, while the age- and gender-adjusted trichiasis prevalence in persons aged ≥15 years ranged from 1.9% (95% CI 1.4-2.5%) in Birnin Kudu to 3.1% (95% CI 2.2-4.0) in Dutse. Access to improved water sources was above 80% in all LGAs surveyed but access to improved sanitation facilities was low, ranging from 23% in Buji to 50% in Kiyawa. CONCLUSION Trachoma is a public health problem in all four LGAs surveyed. The full SAFE strategy needs to be implemented to achieve trachoma elimination.
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Affiliation(s)
- Caleb Mpyet
- Department of Ophthalmology, University of Jos, Jos, Nigeria
- Sightsavers, Kaduna, Nigeria
- Kilimanjaro Centre for Community Ophthalmology International, Division of Ophthalmology, University of Cape Town, Cape Town, South Africa
| | - Nasiru Muhammad
- Ophthalmology Unit, Surgery Department, Usmanu Danfodiyo University, Sokoto, Nigeria
| | | | | | | | | | | | | | | | | | | | | | - 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
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Amnie AG, Emerson P, McFarland D, King J, Miri E, Dickman L. An impact evaluation of two rounds of mass drug administration on the prevalence of active trachoma: A clustered cross sectional survey. PLoS One 2018; 13:e0201911. [PMID: 30157193 PMCID: PMC6114510 DOI: 10.1371/journal.pone.0201911] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 07/24/2018] [Indexed: 11/19/2022] Open
Abstract
Introduction We investigated the impact of two round of mass drug administration on trachoma prevalence in Plateau and Nasarawa States of Nigeria. The mass drug administration was conducted as a component of the SAFE Strategy, a combination of interventions recommended for the global elimination of blinding trachoma. Methods The study consisted of a two-stage cross-sectional clustered sample survey in which 3990 people from 793 households were screened for clinical signs of trachoma. Results Of the total 3990 people examined, 1530 were children, of which 808 (53%) were boys and 704 (47%) were girls. The impact of intervention as measured by the changes in overall prevalence of follicular trachoma were as follows: At baseline the overall prevalence of follicular trachoma among children 1–9 years of age was 6.4%, 95% CI [5.8, 7.0]; the overall prevalence of trachomatous trichiasis in the total population was 0.20%, 95% CI [0.16, 0.25]. At follow up, the overall prevalence of follicular trachoma among children 1–9 years of age was 3.4%, 95% CI [1.9, 4.9]; the overall prevalence of trachomatous trichiasis in the total population was 0.20%, 95% CI [0.00, 0.05]. The highest statistically significant reduction (96%) in follicular trachoma prevalence was observed in Doma Local Government Area of Nasarawa State from baseline prevalence of 13.6%, 95% CI [9.7, 17.5] to follow-up prevalence of 0.5%, 95% CI [0.0, 1.5] and the lowest reduction (58%) in follicular trachoma prevalence was observed in Langtang North Local Government Area of Plateau State from baseline prevalence of 15.8%, 95% CI [9.3, 22.3] to 6.6%, 95% CI [1.6, 11.6], (p<0.05). Conclusion A significant reduction in the overall prevalence of follicular trachoma was achieved after two rounds of mass drug administration. In the absence of significant activities pertaining to facial cleanliness and environmental sanitation components of the SAFE strategy in the intervention areas, the observed deep reductions in prevalence could mainly be attributed to mass drug administration. Therefore, two rounds of mass azithromycin administration may be as effective as guideline-recommended three or more rounds in reducing active trachoma prevalence but findings should be replicated in more robustly designed studies.
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Affiliation(s)
- Asrat Genet Amnie
- Health Education Unit, Education Department, Eugenio María de Hostos Community College, The City University of New York, New York, NY, United States
- * E-mail:
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Butcher RMR, Sokana O, Jack K, Macleod CK, Marks ME, Kalae E, Sui L, Russell C, Tutill HJ, Williams RJ, Breuer J, Willis R, Le Mesurier RT, Mabey DCW, Solomon AW, Roberts CH. Low Prevalence of Conjunctival Infection with Chlamydia trachomatis in a Treatment-Naïve Trachoma-Endemic Region of the Solomon Islands. PLoS Negl Trop Dis 2016; 10:e0004863. [PMID: 27603015 PMCID: PMC5014345 DOI: 10.1371/journal.pntd.0004863] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 06/29/2016] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Trachoma is endemic in several Pacific Island states. Recent surveys across the Solomon Islands indicated that whilst trachomatous inflammation-follicular (TF) was present at levels warranting intervention, the prevalence of trachomatous trichiasis (TT) was low. We set out to determine the relationship between chlamydial infection and trachoma in this population. METHODS We conducted a population-based trachoma prevalence survey of 3674 individuals from two Solomon Islands provinces. Participants were examined for clinical signs of trachoma. Conjunctival swabs were collected from all children aged 1-9 years. We tested swabs for Chlamydia trachomatis (Ct) DNA using droplet digital PCR. Chlamydial DNA from positive swabs was enriched and sequenced for use in phylogenetic analysis. RESULTS We observed a moderate prevalence of TF in children aged 1-9 years (n = 296/1135, 26.1%) but low prevalence of trachomatous inflammation-intense (TI) (n = 2/1135, 0.2%) and current Ct infection (n = 13/1002, 1.3%) in children aged 1-9 years, and TT in those aged 15+ years (n = 2/2061, 0.1%). Ten of 13 (76.9%) cases of infection were in persons with TF or TI (p = 0.0005). Sequence analysis of the Ct-positive samples yielded 5/13 (38%) complete (>95% coverage of reference) genome sequences, and 8/13 complete plasmid sequences. Complete sequences all aligned most closely to ocular serovar reference strains. DISCUSSION The low prevalence of TT, TI and Ct infection that we observed are incongruent with the high proportion of children exhibiting signs of TF. TF is present at levels that apparently warrant intervention, but the scarcity of other signs of trachoma indicates the phenotype is mild and may not pose a significant public health threat. Our data suggest that, whilst conjunctival Ct infection appears to be present in the region, it is present at levels that are unlikely to be the dominant driving force for TF in the population. This could be one reason for the low prevalence of TT observed during the study.
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Affiliation(s)
- Robert M. R. Butcher
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Oliver Sokana
- Eye Department, Solomon Islands Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - Kelvin Jack
- Eye Department, Solomon Islands Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - Colin K. Macleod
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Sightsavers, Haywards Heath, United Kingdom
| | - Michael E. Marks
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Hospital for Tropical Diseases, University College London Hospitals, London, United Kingdom
| | - Eric Kalae
- Primary Care Department, Lata Hospital, Lata, Santa Cruz, Solomon Islands
| | - Leslie Sui
- Primary Care Department, Lata Hospital, Lata, Santa Cruz, Solomon Islands
| | | | - Helena J. Tutill
- Division of Infection & Immunity, Faculty of Medical Sciences, University College London, London, United Kingdom
| | - Rachel J. Williams
- Division of Infection & Immunity, Faculty of Medical Sciences, University College London, London, United Kingdom
| | - Judith Breuer
- Division of Infection & Immunity, Faculty of Medical Sciences, University College London, London, United Kingdom
| | - Rebecca Willis
- Task Force for Global Health, Decatur, Georgia, United States of America
| | - Richard T. Le Mesurier
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - David C. W. Mabey
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Hospital for Tropical Diseases, University College London Hospitals, London, United Kingdom
| | - Anthony W. Solomon
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Chrissy h. Roberts
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
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10
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Mpyet C, Kello AB, Solomon AW. Global Elimination of Trachoma by 2020: A Work in Progress. Ophthalmic Epidemiol 2016; 22:148-50. [PMID: 26158572 DOI: 10.3109/09286586.2015.1045987] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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11
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Smith JL, Sivasubramaniam S, Rabiu MM, Kyari F, Solomon AW, Gilbert C. Multilevel Analysis of Trachomatous Trichiasis and Corneal Opacity in Nigeria: The Role of Environmental and Climatic Risk Factors on the Distribution of Disease. PLoS Negl Trop Dis 2015. [PMID: 26222549 PMCID: PMC4519340 DOI: 10.1371/journal.pntd.0003826] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The distribution of trachoma in Nigeria is spatially heterogeneous, with large-scale trends observed across the country and more local variation within areas. Relative contributions of individual and cluster-level risk factors to the geographic distribution of disease remain largely unknown. The primary aim of this analysis is to assess the relationship between climatic factors and trachomatous trichiasis (TT) and/or corneal opacity (CO) due to trachoma in Nigeria, while accounting for the effects of individual risk factors and spatial correlation. In addition, we explore the relative importance of variation in the risk of trichiasis and/or corneal opacity (TT/CO) at different levels. Data from the 2007 National Blindness and Visual Impairment Survey were used for this analysis, which included a nationally representative sample of adults aged 40 years and above. Complete data were available from 304 clusters selected using a multi-stage stratified cluster-random sampling strategy. All participants (13,543 individuals) were interviewed and examined by an ophthalmologist for the presence or absence of TT and CO. In addition to field-collected data, remotely sensed climatic data were extracted for each cluster and used to fit Bayesian hierarchical logistic models to disease outcome. The risk of TT/CO was associated with factors at both the individual and cluster levels, with approximately 14% of the total variation attributed to the cluster level. Beyond established individual risk factors (age, gender and occupation), there was strong evidence that environmental/climatic factors at the cluster-level (lower precipitation, higher land surface temperature, higher mean annual temperature and rural classification) were also associated with a greater risk of TT/CO. This study establishes the importance of large-scale risk factors in the geographical distribution of TT/CO in Nigeria, supporting anecdotal evidence that environmental conditions are associated with increased risk in this context and highlighting their potential use in improving estimates of disease burden at large scales. Trichiasis (TT) and corneal opacity (CO) are chronic stages of trachoma, which remains an important cause of blindness. This study used multilevel spatial models to investigate risk factors for TT/CO in Nigeria, including data for more than 13,500 adults aged 40 years and above collected in the 2007 National Blindness and Visual Impairment survey. Individual-level risk factors were consistent with those identified in other studies, including a higher risk in females, older individuals and those with lower socioeconomic status. After controlling for these factors, there was evidence that a number of environmental and climatic factors are associated with the distribution of TT/CO in Nigeria. These findings establish for the Nigerian context the importance of risk factors at different scales for the later stages of trachoma, supporting anecdotal evidence that hotter, drier environmental conditions are associated with increased risk.
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Affiliation(s)
- Jennifer L. Smith
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Global Health Group, University of California San Francisco, San Francisco, California, United States of America
- * E-mail:
| | - Selvaraj Sivasubramaniam
- Medical Statistics Team, Division of Applied Health Sciences, University of Aberdeen, United Kingdom
| | | | - Fatima Kyari
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- College of Health Sciences of University of Abuja, Abuja, Nigeria
| | - Anthony W. Solomon
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Clare Gilbert
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
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12
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Muhammad N, Mohammed A, Isiyaku S, Adamu MD, Gwom A, Rabiu MM. Mapping trachoma in 25 local government areas of Sokoto and Kebbi states, northwestern Nigeria. Br J Ophthalmol 2013; 98:432-7. [PMID: 24344228 DOI: 10.1136/bjophthalmol-2013-303703] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The WHO global initiative on elimination of trachoma by 2020 (GET 2020) recommends mapping of trachoma at district (Local Government Area (LGA)) levels to enable planning and control activities in affected communities worldwide. The aim of the present study was to provide baseline data on trachoma for the LGAs of Sokoto and Kebbi states, Nigeria. METHODS A population-based cross-sectional survey was conducted in 25 LGAs between November 2011 and May 2012. The WHO guidelines for trachoma control and risk factor assessment were used in the planning and conduct of the survey. RESULTS The prevalence of trachomatous inflammation-follicular in children aged 1-9 years ranged from 0.3% in Sokoto South to 15.6% in Kalgo LGA. The prevalence of trachomatous trichiasis (TT) in adults (>14 years) ranged from 0.03% in three LGAs to 0.6% in Gudu LGA. Logistic regression analysis for the trachoma risk factors after χ(2) analysis showed only distance from water source as a significant risk factor (OR>1, p<0.5). Clean face, access to latrines and knowledge of trachoma prevention were significantly protective (OR<1, p<0.5) against active disease. The average number of persons in need of TT lid surgery ranged from 0 in 3 LGAs to 397 in Danko-Wasagu LGA. Mass antibiotic distribution is needed in 4 LGAs. The estimated number of households in need of latrines and improved water sources are high, with 1 LGA requiring 34 500 latrines and 20 000 improved water sources. CONCLUSIONS There is a burden of active trachoma of different endemicity levels in all the surveyed LGAs. The burden of trachoma risk factors remains a challenge despite the global effort to decrease the risk factors through the Millennium Development Goals.
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Affiliation(s)
- N Muhammad
- Ophthalmology Unit, Surgery Department, Usmanu Danfodiyo University, , Sokoto, Nigeria
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13
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Cromwell EA, Amza A, Kadri B, Beidou N, King JD, Sankara D, Mosher AW, Hassan S, Kane S, Emerson PM. Trachoma prevalence in Niger: results of 31 district-level surveys. Trans R Soc Trop Med Hyg 2013; 108:42-8. [PMID: 24281748 DOI: 10.1093/trstmh/trt101] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The leading cause of preventable blindness worldwide is trachoma, a condition caused by an infection of the inner eyelid. In Niger, a landlocked republic in Western Africa, surveys in 1988-89 identified trachoma as endemic in all but one region and, as a result, there is a National Prevention of Blindness Program plan to eliminate trachoma by 2015. METHODS Thirty-one districts in eastern and western Niger were surveyed for trachoma prevalence from May 2009 to March 2012 as part of routine program impact evaluations. Prevalence surveys were implemented independently in each district using a two-stage cluster random design. Probability proportional to size was used to randomly select villages and 25 households were selected in each cluster. The prevalence of trachoma of clinical grade trachomatous follicular (TF) was estimated in children aged 1-9 years, and the prevalence of blinding trachoma, trachomatous trichiasis (TT), was measured in adults aged ≥15 years. RESULTS A total of 14 211 households was surveyed; 58 617 individuals were evaluated for clinical signs of trachoma, of whom 27 087 were children aged 1-9 years. District-wide implementation of the full SAFE strategy is warranted in 16 districts where TF prevalence exceeds 10% and targeted implementation of the SAFE strategy (surgery for trichiasis; antibiotic therapy to control transmission; facial cleanliness for hygiene promotion; environmental change for improvements in access to water and sanitation) is recommended in the remaining 15 districts. The prevalence of TT among adults exceeded 1% in nine districts, suggesting that surgical services to treat TT should be implemented district-wide. CONCLUSIONS These results establish the need for continued SAFE strategy implementation throughout Niger.
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Affiliation(s)
- Elizabeth A Cromwell
- The Carter Center, Trachoma Control Program, 1149 Ponce de Leon, Atlanta GA 30306, USA
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King JD, Odermatt P, Utzinger J, Ngondi J, Bamani S, Kamissoko Y, Boubicar K, Hassan AS, Nwobi BC, Jip N, Amnie A, Teferi T, Mosher AW, Stewart AEP, Cromwell EA, Emerson PM. Trachoma among children in community surveys from four African countries and implications of using school surveys for evaluating prevalence. Int Health 2013; 5:280-7. [PMID: 24179180 DOI: 10.1093/inthealth/iht027] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND School surveys provide a convenient platform to obtain large child cohorts from multiple communities and are widely used as a proxy to determine community prevalence of neglected tropical diseases. The purpose of this study was to compare trachoma prevalence between preschool- and school-aged children and children who attend and do not attend school. METHODS We analysed data from community-based trachoma surveys conducted from 2008-2011 in Ethiopia, Mali, Niger and Nigeria. The surveys utilised a cross-sectional, randomised cluster design. Individual-level data on school attendance was collected. RESULTS Overall, 75 864 children aged 1-15 years from 2100 communities were included in the analysis. The prevalence of trachomatous inflammation follicular (TF) among these children in surveyed districts was 19.1% (95% CI 17.9-20.2%) in Ethiopia, 6.2% (95% CI 5.4-6.9%) in Niger, 4.6% (95% CI 4.2-4.9%) in Mali and 4.2% (95% CI 3.5-4.9%) in Nigeria. Controlling for age, sex and clustering, the OR of TF for school-attendees compared to non-attendees was 0.64 (95% CI 0.56-0.73) in Ethiopia, 0.67 (95% CI 0.56-0.80) in Mali, 1.03 (95% CI 0.81-1.16) in Niger and 1.06, (95% CI 0.65-1.73) in Nigeria. CONCLUSION Estimating the prevalence of trachoma through examination of only school-going children risks underestimating the true prevalence.
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Affiliation(s)
- Jonathan D King
- The Carter Center, 1149 Ponce de Leon Ave, Atlanta, GA 30306, USA
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King JD, Buolamwini J, Cromwell EA, Panfel A, Teferi T, Zerihun M, Melak B, Watson J, Tadesse Z, Vienneau D, Ngondi J, Utzinger J, Odermatt P, Emerson PM. A novel electronic data collection system for large-scale surveys of neglected tropical diseases. PLoS One 2013; 8:e74570. [PMID: 24066147 PMCID: PMC3774718 DOI: 10.1371/journal.pone.0074570] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 08/05/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Large cross-sectional household surveys are common for measuring indicators of neglected tropical disease control programs. As an alternative to standard paper-based data collection, we utilized novel paperless technology to collect data electronically from over 12,000 households in Ethiopia. METHODOLOGY We conducted a needs assessment to design an Android-based electronic data collection and management system. We then evaluated the system by reporting results of a pilot trial and from comparisons of two, large-scale surveys; one with traditional paper questionnaires and the other with tablet computers, including accuracy, person-time days, and costs incurred. PRINCIPLE FINDINGS The electronic data collection system met core functions in household surveys and overcame constraints identified in the needs assessment. Pilot data recorders took 264 (standard deviation (SD) 152 sec) and 260 sec (SD 122 sec) per person registered to complete household surveys using paper and tablets, respectively (P = 0.77). Data recorders felt a lack of connection with the interviewee during the first days using electronic devices, but preferred to collect data electronically in future surveys. Electronic data collection saved time by giving results immediately, obviating the need for double data entry and cross-correcting. The proportion of identified data entry errors in disease classification did not differ between the two data collection methods. Geographic coordinates collected using the tablets were more accurate than coordinates transcribed on a paper form. Costs of the equipment required for electronic data collection was approximately the same cost incurred for data entry of questionnaires, whereas repeated use of the electronic equipment may increase cost savings. CONCLUSIONS/SIGNIFICANCE Conducting a needs assessment and pilot testing allowed the design to specifically match the functionality required for surveys. Electronic data collection using an Android-based technology was suitable for a large-scale health survey, saved time, provided more accurate geo-coordinates, and was preferred by recorders over standard paper-based questionnaires.
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Affiliation(s)
- Jonathan D. King
- The Carter Center, Atlanta, Georgia, United States of America
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Joy Buolamwini
- Department of Computer Science, Georgia Institute of Technology, Atlanta, United States of America
| | | | - Andrew Panfel
- Department of Computer Science, Georgia Institute of Technology, Atlanta, United States of America
| | | | | | | | - Jessica Watson
- Department of Computer Science, Georgia Institute of Technology, Atlanta, United States of America
| | | | - Danielle Vienneau
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Jeremiah Ngondi
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
| | - Jürg Utzinger
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Peter Odermatt
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Paul M. Emerson
- The Carter Center, Atlanta, Georgia, United States of America
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Cromwell EA, King JD, McPherson S, Jip FN, Patterson AE, Mosher AW, Evans DS, Emerson PM. Monitoring of mass distribution interventions for trachoma in Plateau State, Nigeria. PLoS Negl Trop Dis 2013; 7:e1995. [PMID: 23326617 PMCID: PMC3542118 DOI: 10.1371/journal.pntd.0001995] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 11/15/2012] [Indexed: 12/02/2022] Open
Abstract
Mass drug administration (MDA) with antibiotics is a key component of the SAFE strategy for trachoma control. Guidelines recommend that where MDA is warranted the whole population be targeted with 80% considered the minimum acceptable coverage. In other countries, MDA is usually conducted by salaried Ministry of Health personnel (MOH). In Plateau State, Nigeria, the existing network of volunteer Community Directed Distributors (CDD) was used for the first trachoma MDA. We conducted a population-based cluster random survey (CRS) of MDA participation to determine the true coverage and compared this to coverage reported from CDD registers. We surveyed 1,791 people from 352 randomly selected households in 24 clusters in three districts in Plateau State in January 2011, following the implementation of MDA. Households were enumerated and all individuals present were asked about MDA participation. Household heads were questioned about household-level characteristics and predictors of participation. Individual responses were compared with the CDD registers. MDA coverage was estimated as 60.3% (95% CI 47.9–73.8%) by the survey compared with 75.8% from administrative program reports. CDD registration books for comparison with responses were available in 19 of the 24 clusters; there was a match for 658/682 (96%) of verifiable responses. CDD registers did not list 481 (41.3%) of the individuals surveyed. Gender and age were not associated with individual participation. Overall MDA coverage was lower than the minimum 80% target. The observed discrepancy between the administrative coverage estimate from program reports and the CRS was largely due to identification of communities missed by the MDA and not reported in the registers. CRS for evaluation of MDA provides a useful additional monitoring tool to CDD registers. These data support modification of distributor training and MDA delivery to increase coverage in subsequent rounds of MDA. The World Health Organization recommends that mass drug administration for trachoma control reach a minimum of 80% of the target population. Previous evaluations of MDA coverage have demonstrated that administrative reports can bias coverage estimates. A survey of participation in mass drug administration for trachoma control was implemented in three districts in Plateau State, Nigeria in 2011 to validate coverage calculated from treatment registers. A total of 352 households were surveyed from 24 randomly selected communities. Heads of household were interviewed to identify household-level characteristics and predictors of participation. Individual household members were enumerated and those present at the time of interview were asked to report individual participation in the MDA. Responses were verified against the community-drug distributor registration log. Approximately 60% of the sample reported receiving either tetracycline eye ointment or azithromycin for trachoma control. Administrative data on treatment estimated coverage at 76% for the three LGAs. The discrepancy between the coverage estimate from administrative data (calculated by the program) and the survey data suggest that cluster random surveys of MDA provide a useful monitoring tool to validate administrative data on treatment coverage. These data support modification of distributor training and MDA delivery to increase coverage in subsequent rounds of MDA.
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Affiliation(s)
| | | | - Scott McPherson
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | | | | | - Aryc W. Mosher
- The Carter Center, Atlanta, Georgia, United States of America
| | - Darin S. Evans
- The Carter Center, Atlanta, Georgia, United States of America
| | - Paul M. Emerson
- The Carter Center, Atlanta, Georgia, United States of America
- * E-mail:
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King JD, Eigege A, Umaru J, Jip N, Miri E, Jiya J, Alphonsus KM, Sambo Y, Graves P, Richards F. Evidence for stopping mass drug administration for lymphatic filariasis in some, but not all local government areas of Plateau and Nasarawa States, Nigeria. Am J Trop Med Hyg 2012; 87:272-80. [PMID: 22855758 DOI: 10.4269/ajtmh.2012.11-0718] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
An average of six annual rounds of ivermectin and albendazole were distributed in Plateau and Nasarawa States, Nigeria, to eliminate lymphatic filariasis. From 2007 to 2008, population-based surveys were implemented in all 30 local government areas (LGAs) of the two states to determine the prevalence of Wuchereria bancrofti antigenemia to assess which LGA mass drug administration (MDA) could be halted. In total, 36,681 persons from 7,819 households were examined for filarial antigen as determined by immunochromatographic card tests. Overall antigen prevalence was 3.05% (exact upper 95% confidence interval [CI] = 3.41%) with an upper 95% CI range by LGA of 0.50-19.3%. Among 3,233 children 6-7 years of age, overall antigen prevalence was 1.71% (exact upper 95% CI = 2.19%), too high to recommend generally halting MDA in the two-state area. However, based on criteria of < 2% antigenemia among persons > 2 years of age, stopping MDA was recommended for 10 LGAs.
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Affiliation(s)
- Jonathan D King
- The Carter Center, Atlanta, Georgia; The Carter Center, Jos, Plateau State, Nigeria.
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