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Kilangalanga J, Ndjemba JM, Uvon PA, Kibangala FM, Mwandulo JLSB, Mavula N, Ndombe M, Kazadi J, Limbaka H, Cohn D, Tougoue JJ, Kabore A, Rotondo L, Willis R, Bio AA, Kadri B, Bakhtiari A, Ngondi JM, Solomon AW, For The Global Trachoma Mapping Project. Trachoma in the Democratic Republic of the Congo: Results of 46 Baseline Prevalence Surveys Conducted with the Global Trachoma Mapping Project. Ophthalmic Epidemiol 2017; 25:192-200. [PMID: 28850014 PMCID: PMC6319181 DOI: 10.1080/09286586.2017.1306869] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Purpose: Trachoma was suspected to be endemic in parts of the Democratic Republic of the Congo (DRC). We aimed to estimate prevalences of trachomatous inflammation–follicular (TF), trichiasis, and water and sanitation (WASH) indicators in suspected-endemic Health Zones. Methods: A population-based prevalence survey was undertaken in each of 46 Health Zones across nine provinces of DRC, using Global Trachoma Mapping Project methods. A two-stage cluster random sampling design was used in each Health Zone, whereby 25 villages (clusters) and 30 households per cluster were sampled. Consenting eligible participants (children aged 1–9 years and adults aged ≥15 years) were examined for trachoma by GTMP-certified graders; households were assessed for access to WASH. Results: A total of 32,758 households were surveyed, and 141,853 participants (98.2% of those enumerated) were examined for trachoma. Health Zone-level TF prevalence in 1–9-year-olds ranged from 1.9–41.6%. Among people aged ≥15 years, trichiasis prevalences ranged from 0.02–5.1% (95% CI 3.3–6.8). TF prevalence in 1–9-year-olds was ≥5% in 30 Health Zones, while trichiasis prevalence was ≥0.2% in 37 Health Zones. Conclusion: Trachoma is a public health problem in 39 of 46 Health Zones surveyed. To meet elimination targets, 37 Health Zones require expanded trichiasis surgery services while 30 health zones require antibiotics, facial cleanliness and environmental improvement interventions. Survey data suggest that trachoma is widespread: further surveys are warranted.
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Affiliation(s)
| | - Jean Marie Ndjemba
- b Neglected Tropical Diseases Unit, Ministère de la Santé Publique , Kinshasa , Democratic Republic of the Congo
| | - Pitchouna A Uvon
- b Neglected Tropical Diseases Unit, Ministère de la Santé Publique , Kinshasa , Democratic Republic of the Congo
| | - Felix M Kibangala
- b Neglected Tropical Diseases Unit, Ministère de la Santé Publique , Kinshasa , Democratic Republic of the Congo
| | | | - Nicaise Mavula
- c RTI International , Kinshasa , Democratic Republic of the Congo
| | - Martin Ndombe
- c RTI International , Kinshasa , Democratic Republic of the Congo
| | - Junior Kazadi
- d World Vision International , Kinshasa , Democratic Republic of the Congo
| | - Henry Limbaka
- e Christian Blind Mission , Kinshasa , Democratic Republic of the Congo
| | | | | | | | | | | | | | | | | | | | - Anthony W Solomon
- k Clinical Research Department , London School of Hygiene & Tropical Medicine , London , UK.,l Department of Control of Neglected Tropical Diseases , World Health Organization , Geneva , Switzerland
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Challa P, Herndon LW, Hauser MA, Broomer BW, Pericak-Vance MA, Ababio-Danso B, Allingham RR. Prevalence of myocilin mutations in adults with primary open-angle glaucoma in Ghana, West Africa. J Glaucoma 2002; 11:416-20. [PMID: 12362081 DOI: 10.1097/00061198-200210000-00008] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Investigators have noted that primary open-angle glaucoma (POAG) in West Africa has an earlier age of onset and appears to be more clinically severe than in the United States and Europe. Primary open-angle glaucoma patients with mutations in myocilin have a similar phenotype. Therefore, we investigated the role of mutations in myocilin in patients with POAG in a West African population. MATERIALS AND METHODS Patients seen at the Emmanuel Eye Clinic in Accra, Ghana, were recruited for this study. Informed consent was obtained from all study patients. Glaucoma specialists from the sponsoring institution (PC, LWH, or RRA) ascertained all POAG and control patients. Age-matched unaffected controls were obtained in patients with an IOP < 22 mm Hg and normal-appearing optic nerves. PCR amplification of each of the three myocilin exons was performed. Denaturing high-performance liquid chromatography (Transgenomics Corp.) was used to detect allelic differences and samples demonstrating a mobility shift were sequenced in both directions. RESULTS Ninety unrelated affecteds with POAG and 76 control patients were recruited. Four individuals with severe POAG were found to have novel missense mutations in exon 3. Two exhibit an Asp380Asn mutation and two an Arg342Lys mutation. These changes were not detected in 152 ethnically matched control chromosomes. Fourteen affected individuals and eight controls exhibit a translationally silent polymorphism in codon 325 (Thr325Thr). CONCLUSIONS A total of 4.4% of patients with POAG have novel disease-associated mutations in myocilin. Mutations in myocilin appear to play a limited role in the pathogenesis of POAG in this region of West Africa.
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Affiliation(s)
- P Challa
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina 27712, USA.
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Herndon LW, Challa P, Ababio-Danso B, Boateng JO, Broomer B, Ridenhour P, Allingham RR. Survey of glaucoma in an eye clinic in Ghana, West Africa. J Glaucoma 2002; 11:421-5. [PMID: 12362082 DOI: 10.1097/00061198-200210000-00009] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To report the various types of glaucoma among West African patients presenting to an eye clinic in Ghana. METHODS A complete evaluation was performed in 198 consecutive Ghanaian glaucoma patients. Main outcome measures included intraocular pressure, visual acuity, gonioscopy findings, visual field, and total number of glaucoma medications. RESULTS The most common form of glaucoma was primary open-angle glaucoma (44.2%). Open-angle glaucoma suspects also comprised a large percentage of the group (30.5%). Chronic angle-closure glaucoma was diagnosed in 6.6% of the patients. CONCLUSIONS Primary open-angle glaucoma is the most common form of glaucoma being treated in this outpatient eye clinic in Ghana. Chronic angle-closure glaucoma was the second most common form of glaucoma in this series and was usually undiagnosed due to a lack of gonioscopic evaluation. Gonioscopy is an important diagnostic tool that should be promoted to guide more effective glaucoma treatment in this region. Pseudoexfoliation and pseudoexfoliation-associated glaucoma were not seen in this population.
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Affiliation(s)
- Leon W Herndon
- Duke University Eye Center, Durham, North Carolina 27710, USA
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Egbert PR, Williams AS, Singh K, Dadzie P, Egbert TB. A prospective trial of intraoperative fluorouracil during trabeculectomy in a black population. Am J Ophthalmol 1993; 116:612-6. [PMID: 8238222 DOI: 10.1016/s0002-9394(14)73204-0] [Citation(s) in RCA: 74] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
In a study population of black Africans with advanced glaucoma in Ghana we conducted a prospective study of intraoperative 5-fluorouracil alone. Eyes undergoing trabeculectomy were randomly selected either to receive or not receive a single intraoperative application of 5-fluorouracil (50 mg/ml for five minutes). Fifty-five eyes had a mean follow-up of 282 days (minimum, 92 days). Twenty of 24 eyes (83%) in the 5-fluorouracil group vs 12 of 31 eyes (39%) in the control group had postoperative intraocular pressure of 20 mm Hg or less with or without medical therapy (P = .01). Eleven of 24 eyes (46%) in the 5-fluorouracil group and five of 31 eyes (16%) in the control group had intraocular pressure of 15 mm Hg or less (P = .02). Without medical therapy, 17 of 24 eyes (71%) in the 5-fluorouracil group and ten of 31 eyes (32%) in the control group had intraocular pressure of 20 mm Hg or less (P = .02). The overall complications were similar in the two groups. In this population, intraoperative 5-fluorouracil markedly improved the ability of trabeculectomy to lower intraocular pressure. We recommend that intraoperative 5-fluorouracil be considered in glaucoma surgery with poor prognosis as an alternative to postoperative subconjunctival injections when multiple injections are not feasible.
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Affiliation(s)
- P R Egbert
- Department of Ophthalmology, Stanford University Medical Center, CA 94305-5308
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Wormald R, Foster A. Clinical and pathological features of chronic glaucoma in north-east Ghana. Eye (Lond) 1990; 4 ( Pt 1):107-14. [PMID: 2323461 DOI: 10.1038/eye.1990.13] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Of 34 consecutive patients with chronic glaucoma seen in north-east Ghana, 22 (65%) were male and seven (21%) were aged under 40 years. Only 17% of eyes had a visual acuity better than 6/18 at presentation. Sixteen of 23 patients who underwent gonioscopy had PAS of which 13 had positive skin snips for onchocerciasis, compared with two out of seven patients with positive skin snips who had open angle glaucoma (p = 0.003). Of 22 trabecular meshworks examined by light microscopy ten (45%) showed marked melanin pigmentation which was more common in younger patients but did not correlate with onchocerciasis infection.
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Affiliation(s)
- R Wormald
- Department of Preventive Ophthalmology, Institute of Ophthalmology, London
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