Gender differences in the surgical management of trachomatous trichiasis: an exploratory analysis of global trachoma survey data, 2015-2019

BACKGROUND

Trachomatous trichiasis (TT) is a painful, potentially blinding eye condition that can be managed through epilation or surgery. Women are affected by TT approximately twice as often as men and are believed to face gendered barriers to receiving surgical care to prevent vision loss.

METHODS

We used data from 817 cross-sectional surveys conducted during 2015-2019 in 20 African countries to estimate the prevalence difference (PD) between female and male eyes for four outcomes potentially indicating gender-related differences in TT management: (1) received surgery and developed postoperative TT (PTT), (2) never offered surgery, (3) offered surgery but declined it, and (4) offered epilation but never offered surgery.

RESULTS

The prevalence was modestly elevated among female eyes compared with male eyes for having PTT (PD:1.8 [95% confidence limits (CL): 0.6, 3.0]) and having declined surgery for the eye (PD: 6.2 [95% CL: 1.8, 10.7]). The proportion offered epilation was similar by gender (PD:0.5 [95% CL: -0.4, 1.3]), while never having been offered surgery was somewhat more prevalent among male eyes (PD: -2.1 [95% CL: -3.5, -0.7]).

CONCLUSIONS

Our results suggest potential gender differences in TT management. More research is needed to determine the causes and implications of the observed differences.

Tropical Data: Approach and Methodology as Applied to Trachoma Prevalence Surveys

PURPOSE

Population-based prevalence surveys are essential for decision-making on interventions to achieve trachoma elimination as a public health problem. This paper outlines the methodologies of Tropical Data, which supports work to undertake those surveys.

METHODS

Tropical Data is a consortium of partners that supports health ministries worldwide to conduct globally standardised prevalence surveys that conform to World Health Organization recommendations. Founding principles are health ministry ownership, partnership and collaboration, and quality assurance and quality control at every step of the survey process. Support covers survey planning, survey design, training, electronic data collection and fieldwork, and data management, analysis and dissemination. Methods are adapted to meet local context and needs. Customisations, operational research and integration of other diseases into routine trachoma surveys have also been supported.

RESULTS

Between 29th February 2016 and 24th April 2023, 3373 trachoma surveys across 50 countries have been supported, resulting in 10,818,502 people being examined for trachoma.

CONCLUSION

This health ministry-led, standardised approach, with support from the start to the end of the survey process, has helped all trachoma elimination stakeholders to know where interventions are needed, where interventions can be stopped, and when elimination as a public health problem has been achieved. Flexibility to meet specific country contexts, adaptation to changes in global guidance and adjustments in response to user feedback have facilitated innovation in evidence-based methodologies, and supported health ministries to strive for global disease control targets.

The global burden of trichiasis in 2016

Background

Trichiasis is present when one or more eyelashes touches the eye. Uncorrected, it can cause blindness. Accurate estimates of numbers affected, and their geographical distribution, help guide resource allocation.

Methods

We obtained district-level trichiasis prevalence estimates in adults for 44 endemic and previously-endemic countries. We used (1) the most recent data for a district, if more than one estimate was available; (2) age- and sex-standardized corrections of historic estimates, where raw data were available; (3) historic estimates adjusted using a mean adjustment factor for districts where raw data were unavailable; and (4) expert assessment of available data for districts for which no prevalence estimates were available.

Findings

Internally age- and sex-standardized data represented 1,355 districts and contributed 662 thousand cases (95% confidence interval [CI] 324 thousand–1.1 million) to the global total. Age- and sex-standardized district-level prevalence estimates differed from raw estimates by a mean factor of 0.45 (range 0.03–2.28). Previously non- stratified estimates for 398 districts, adjusted by ×0.45, contributed a further 411 thousand cases (95% CI 283–557 thousand). Eight countries retained previous estimates, contributing 848 thousand cases (95% CI 225 thousand-1.7 million). New expert assessments in 14 countries contributed 862 thousand cases (95% CI 228 thousand–1.7 million). The global trichiasis burden in 2016 was 2.8 million cases (95% CI 1.1–5.2 million).

Interpretation

The 2016 estimate is lower than previous estimates, probably due to more and better data; scale-up of trichiasis management services; and reductions in incidence due to lower active trachoma prevalence.

As an individual with trichiasis blinks, the eyelashes abrade the cornea, which can lead to corneal opacity and blindness. Through high quality surgery, which involves altering the position of the eyelid margin, it is possible to reduce the number of people with trichiasis. Accurate estimates of the number of persons with trichiasis and their geographical distribution are needed in order to effectively align resources for surgery and other necessary services. We obtained district-level trichiasis prevalence estimates for 44 endemic and previously-endemic countries. We used the most recently available data and expert assessments to estimate the global burden of trichiasis. We estimated that in 2016 the global burden was 2.8 million cases (95% CI 1.1–5.2 million).

The 2016 estimate is lower than previous estimates, probably due to more and better data; scale-up of trichiasis management services; and reductions in incidence due to lower active trachoma prevalence.

[Treatment of ocular lesions due to Elapidae venom spitting in Central African Republic: epidemiological and clinical aspects]

This survey concerns 16 patients admitted to Bangui teaching national hospital center, coming from Ngakobo health center 450 km from the South East of Bangui, between September 2001 and May 2002. All of them have undergone a basic ophthalmological examination 16 patients have been hospitalised in the service of ophthalmology among them, 11 didn't go to the consultation. All the 16 patients were males, 18 to 46 years old. Five of them had bilateral corneal lesions and eleven patients presented unilateral lesions. Two patients had a corneal perforation at admission. The initial visual acuity of the concerned eye was estimated between LP(-) and 3/10th. The visual acuity valued after exit was LP(-) to 6/10. Four patients out of sixteen (two eyes with bilateral lesions and two with unilateral lesion) (six eyes) received as initial treatment, water rinse on the spot of the accident, then a local treatment by antibiotics administrated in the dispensary of the Ngakobo Province. Eight patients (two bilateral and six unilateral lesions) received a traditional treatment while five of them received it before their transfer to Bangui and 3 patients just before their arrival in Bangui. Four patients (five eyes) had no treatment at all. The nature of this traditional treatment, often of mineral and vegetal origin has not been specified. The main after-effects are corneal opacities, varying according to size, localization and gravity. At the beginning, 9 cases out 16 are generally diffused and superficial keratitis. After some days of treatment, 8 cases developed into corneal opacity freeing thus the visual axis. 3 cases of keratitis developed into a purulent melting then to a corneal perforation. Elapidae's spits on the eye are frequent in sugar cane cultivation areas. They can provoke some severe erosive corneal lesions, in absence of adequate and early management. The administration of traditional treatment most often complicates the clinical issue. Nursing staff, medical personnel and family should pay attention to the ocular toxicity of these septic matters and to the first cares provided to the patient before his early transfer to hospital.

[Characteristics of ophthalmic symptoms in the 278 patients with human immunodeficiency virus]

OBJECTIVE

To investigate the characteristics of ophthalmic symptoms of patients with human immunodeficiency virus (HIV) and to provide reference for early diagnosis and treatment of HIV.

METHODS

The clinical data of 278 patients with HIV, including ophthalmic symptoms and general condition collected from September 2002 to July 2004, were analyzed retrospectively. These patients were from the Central African Republic.

RESULTS

Among the 278 patients with HIV, 102 had pathologic changes in the eyes and were accompanied with chronic dissipative symptoms and decreased CD4 cell counts. The pathogen of 278 patients with HIV at the initial reception were airway infection (n = 87, 31.3%), digestive tract infection (n = 65, 23.4%), skin symptoms (n = 55, 19.8%), multiple organ failure (n = 51, 18.4%) and ophthalmic symptoms (n = 20, 7.2%). Ophthalmic symptoms manifested as opportunistic infection and sarcoma formation, such as HIV retinopathy, chronic uveitis, external ophthalmoplegia, ocular herpes, and Kaposi's sarcoma in the eyelid. HIV-related retinopathy was not specific, which manifested as retinal hemorrhage, cotton wool spots, vascular occlusion, retinal necrosis, retinal detachment and ocular nerve atrophy.

CONCLUSIONS

Many kinds of ophthalmic symptoms might appear in patients with HIV. Severe retinopathy and uveitis are the main causes of ablepsia. Because of neglecting the ophthalmic symptoms in the early stage, many HIV patients suffer from decreased visual acuity, which may severely affect the quality of their lives. Consequently, ophthalmologists should pay more attention to patients in the early stage of HIV.

Les traumatismes oculaires chez les enfants âgés de 0 à 15 ans

PURPOSE

Ocular injuries in children are frequent and are an ophthalmological emergency. If not managed sufficiently early, these lesions may cause definitive partial loss of vision or blindness. In this survey, the authors analyze different epidemiological and clinical aspects of ocular injuries at the Bangui National Teaching Hospital in the Central African Republic to increase the awareness of children's parents, guardians, and care-takers.

PATIENTS AND METHODS

A prospective study was conducted on 194 cases in the ophthalmology department over a period of 3 years, and included children aged 0-15 years. A total of 197 eyes were examined by the same practitioner, comprising 191 unilateral ocular injuries and three bilateral injuries.

RESULTS

Of the children examined, 59% were males and 41% were females, with a sex ratio of 1.3. The age group with the highest exposure (39.3%) was between 5 and 10 years. Punishments (25.9%), accidents during games (19.3%) and fights (18.8%) were the main sources of these ocular injuries. Consultation most often occurred long after the incident. Only 2.0% were seen before the 6th hour and 43.7% between 48 hours and 1 week. The clinical picture was dominated by bruises posing a therapeutic problem: 25 hyphemas (12.7%), 19 conjunctival injuries (9.6%), 19 lens dislocations with or without vitreous loss (9.6%), 18 trauma-induced cataracts (9.4%), and 15 eye lid injuries with or without lachrymal duct ruptures (7.6%). The most serious injuries were cornea injuries with or without hernia of the iris (19.8%) and nine globe dislocations (4.5%).

CONCLUSION

The frequency and gravity of the lesions identified, the severity of the injuries and the delay in treating these injuries show that the public authorities, parents and child care-takers need more information in order to reduce the frequency of these accidents.

Onchocerciasis and epilepsy: a matched case-control study in the Central African Republic

The occurrence of epileptic seizures during onchocercal infestation has been suspected. Epidemiologic studies are necessary to confirm the relation between onchocerciasis and epilepsy. A matched case-control study was conducted in dispensaries of three northwestern towns of the Central African Republic. Each epileptic case was matched against two nonepileptic controls on the six criteria of sex, age (+/-5 years), residence, treatment with ivermectin, date of last ivermectin dose, and the number of ivermectin doses. Onchocerciasis was defined as at least one microfilaria observed in iliac crest skin snip biopsy. A total of 561 subjects (187 cases and 374 controls) were included in the study. Of the epileptics, 39.6% had onchocerciasis, as did 35.8% of the controls. The mean dermal microfilarial load was 26 microfilariae per mg of skin (standard deviation, 42) in the epileptics and 24 microfilariae per mg of skin (standard deviation, 48) in the controls. This matched case-control study found some relation (odds ratio = 1.21, 95% confidence interval 0.81-1.80), although it was nonstatistically significant.