To eliminate trachoma: Azithromycin mass drug administration coverage and associated factors among adults in Goro district, Southeast Ethiopia

Assessment of compliance with tetracycline eye ointment treatment to accelerate the elimination of trachoma in Yobe State, Nigeria

BACKGROUND

Trachoma, a neglected tropical disease, remains a significant public health concern in many regions, particularly in sub-Saharan Africa and in Yobe State, Nigeria. One approach for elimination involves administering tetracycline eye ointment (TEO) to children <6 months of age as part of annual mass drug administration (MDA), aligning with the World Health Organization's 'A' component of the SAFE (Surgery, Antibiotics, Facial hygiene and Environmental sanitation) strategy for elimination of trachoma as a public health problem. However, suboptimal compliance rates in affected populations pose challenges, potentially serving as a reservoir for reinfection and hindering progress toward trachoma elimination. This study focuses on assessing compliance with topical TEO during MDA and explores strategies to enhance adherence in trachoma-endemic areas of Yobe State, Nigeria.

METHODS

A mixed research approach was carried out involving interviews with households across 30 communities in five local government areas where TEO was administered during the 2022 round of MDA. Focus group discussions were conducted with subsets of the population who received TEO to gain insights into the underlying reasons for non-compliance and ways to improve compliance. Additionally, healthcare provider perspectives on treatment administration, compliance and community health education were explored.

RESULTS

Findings from this study show that there is already a high level of compliance with TEO usage, however, forgetfulness due to competing domestic chores, insufficient quantity of TEO given for 6-week applications, low awareness about the impact of trachoma infection on the eyes and the stinging feeling after application, especially in children <6 months of age, are some barriers that affect TEO usage compliance. Following up with TEO recipients would remind them to use the ointment as required, while incentivizing health workers and community drug distributors to conduct follow-up visits to households, increasing awareness on the impact of trachoma on the eyes. Increasing the quantity of TEO allocation would also improve compliance.

CONCLUSIONS

Yobe State has made remarkable progress towards eliminating trachoma as a public health problem, as 12 local government areas no longer require MDA. Sustaining this momentum means ensuring high compliance among the population eligible to receive TEO to prevent any reservoir for reinfection in the state.

Access barriers and facilitators to implement mass drugs administration strategies for eliminating trachoma and geohelminthiasis in the department of Amazonas, Colombia

BACKGROUND

One of the most important pillars of action to achieve the elimination of trachoma and soil-transmitted helminth infections as a public health problem is the mass administration, at regular intervals, of azithromycin and anthielmintics, respectively, to a high proportion of the eligible population in endemic areas.

OBJECTIVE

The objective of the study was to identify access barriers and facilitators for achieving coverage goals in the mass drugs administration, azithromycin and albendazole, in the department of Amazonas, Colombia.

METHODOLOGY

Implementation research was used, combining three types of qualitative research methodologies to collect information about access barriers and facilitators already described; These were individual and group interviews, focus group discussions and face-to-face intercultural dialogues. We design, validate and apply different instruments with questions adapted to the context and role of the participants, and recorded and transcribed the sessions and analyzed them in qualitative analysis software. We used the Consolidated Framework for Implementation Research (CFIR) to complement the above instrument questions, to guide data analysis, and apply the Consolidated Criteria for Reporting Qualitative Research (COREQ).

RESULTS

Records of 159 participants were included; 21 individual and 3 group interviews, 6 focus group discussions and 4 intercultural dialogues were carried out. 21 strong, 30 weak, 6 neutral barriers as well as 5 weak and 11 strong facilitators were identified. 62% of the strong barriers and 40% of the weak ones were concentrated in the "Outer Setting Domain". Only 16 facilitators were identified, 44% in the "Innovation" domain.

CONCLUSIONS

Multiple political, administrative, geographical, logistical and cultural access barriers, as well as external and internal migration of the population, explain low coverage in mass administration of azithromycin and albendazole. It is necessary to review them individually to implement an improvement plan that also recognizes the identified facilitators.

Treatment-related characteristics of communities in districts characterized by persistent trachoma: an exploratory descriptive study

BACKGROUND

Despite the implementation of surgery, antibiotics mass administration, facial cleanliness and environmental improvement, commonly known as the SAFE strategy for several years, the persistence and recrudescence of trachoma is a prevailing challenge in Ethiopia. This study explores the treatment-related characteristics of communities within districts characterized by persistent trachoma in southern Ethiopia.

METHODS

Nyangatom and Uba Debretsehay districts are predominantly inhabited by pastoralist and farming communities, respectively. A community-based, exploratory descriptive qualitative study was conducted from June to October 2023. A total of 11 key informant interviews and six focus group discussions were conducted. The interviews and discussions were digitally recorded, transcribed and thematically analysed using Atlas ti. 23.

RESULTS

Districts characterized by persistent trachoma are characterized by segments of populations that have never been treated or suboptimally treated. This is due to the competing priorities faced by providers, the nature of campaigns and the limited ability of logistics to reach the 'must reach' population. Other barriers include limited social support and terrain hindering full geographical and population coverage. Treatment slippage is of particular concern because of treatment fatigue, misinformation and the unavailability of treatments for routine care.

CONCLUSIONS

Communities in districts characterized by persistent and recrudescent trachoma face various socioecological barriers that impact the outcome of SAFE strategy implementation. A mix of both random and systematic omissions of people who need treatment most, such as children and women, was evident.

Factors associated with trachoma in persistently endemic setting in Southern Ethiopia: a community-based cross-sectional study

Introduction

in Ethiopia, despite implementing decades-long surgery, antibiotics, facial cleanliness, and environmental improvement interventions, commonly known as the SAFE strategies, persistence and recrudescence of trachoma are common. There is limited evidence that explained the reasons. This study assesses factors associated with trachoma in persistently endemic settings.

Methods

using a World Health Organization (WHO)-endorsed Global Trachoma Mapping Methodology, a two-stage cluster sampling technique was applied to select 1538 study respondents from 52 clusters. Data was collected using ODK and analysed using SPSS 28. A total of 1522 respondents were enrolled.

Results

the mean age of the respondents was 33.4 and 50.5% of the respondents were females. About 32.3% (CI 30%, 34%) of the households reported the presence of at least one member of the family having one or more symptoms of trachoma. Being from poorer household (AOR=1.36, 95% CI: 1.0,1.75), presence of a household member who did not receive optimum treatment (AOR=2.8, 95% CI: 1.5, 5.2), and less than 3 doses of treatment (AOR=1.94, 95% CI: 1.32, 2.86) and presence of children ever not treated (AOR= 2.5, 95% CI: 1.5, 4.2) are associated with increased risk of manifesting symptoms of trachoma. In contrast, having optimally treated members of household (AOR=11.2,95% CI: 6.5, 19.3) and face washing with soap (AOR=0.59, 95% CI 36, 0.97) were preventive.

Conclusion

trachoma is a persistent problem in the study districts. Generally, persistent, and recrudescent districts are characterised by segments of population missing optimum treatment as well as poor sanitation and hygiene practices. Our evidence supports the importance of adhering to optimal treatment guidelines, leaving no one behind, and the need for adequate treatment coverage.

Incidence of typhoid fever in Burkina Faso, Democratic Republic of the Congo, Ethiopia, Ghana, Madagascar, and Nigeria (the Severe Typhoid in Africa programme): a population-based study

BACKGROUND

Typhoid Fever remains a major cause of morbidity and mortality in low-income settings. The Severe Typhoid in Africa programme was designed to address regional gaps in typhoid burden data and identify populations eligible for interventions using novel typhoid conjugate vaccines.

METHODS

A hybrid design, hospital-based prospective surveillance with population-based health-care utilisation surveys, was implemented in six countries in sub-Saharan Africa. Patients presenting with fever (≥37·5°C axillary or ≥38·0°C tympanic) or reporting fever for three consecutive days within the previous 7 days were invited to participate. Typhoid fever was ascertained by culture of blood collected upon enrolment. Disease incidence at the population level was estimated using a Bayesian mixture model.

FINDINGS

27 866 (33·8%) of 82 491 participants who met inclusion criteria were recruited. Blood cultures were performed for 27 544 (98·8%) of enrolled participants. Clinically significant organisms were detected in 2136 (7·7%) of these cultures, and 346 (16·2%) Salmonella enterica serovar Typhi were isolated. The overall adjusted incidence per 100 000 person-years of observation was highest in Kavuaya and Nkandu 1, Democratic Republic of the Congo (315, 95% credible interval 254-390). Overall, 46 (16·4%) of 280 tested isolates showed ciprofloxacin non-susceptibility.

INTERPRETATION

High disease incidence (ie, >100 per 100 000 person-years of observation) recorded in four countries, the prevalence of typhoid hospitalisations and complicated disease, and the threat of resistant typhoid strains strengthen the need for rapid dispatch and implementation of effective typhoid conjugate vaccines along with measures designed to improve clean water, sanitation, and hygiene practices.

FUNDING

The Bill & Melinda Gates Foundation.