Progress to Eliminate Trachoma as a Public Health Problem in Amhara National Regional State, Ethiopia: Results of 152 Population-Based Surveys

Abstract

Abstract.At baseline in 2006, Amhara National Regional State, Ethiopia, was the most trachoma-endemic region in the country. Trachoma impact surveys (TIS) were conducted in all districts between 2010 and 2015, following 3–5 years of intervention with the WHO-recommended SAFE (surgery, antibiotics, facial cleanliness, and environmental improvement) strategy. A multistage cluster random sampling design was used to estimate the district-level prevalence of trachoma. In total, 1,887 clusters in 152 districts were surveyed, from which 208,265 individuals from 66,089 households were examined for clinical signs of trachoma. The regional prevalence of trachomatous inflammation-follicular (TF) and trachomatous inflammation-intense among children aged 1–9 years was 25.9% (95% CI: 24.9–26.9) and 5.5% (95% CI: 5.2–6.0), respectively. The prevalence of trachomatous scarring and trachomatous trichiasis among adults aged ≥ 15 years was 12.9% (95% CI: 12.2–13.6) and 3.9% (95% CI: 3.7–4.1), respectively. Among children aged 1–9 years, 76.5% (95% CI: 75.3–77.7) presented with a clean face; 66.2% (95% CI: 64.1–68.2) of households had access to water within 30 minutes round-trip, 48.1% (95% CI: 45.5–50.6) used an improved water source, and 46.2% (95% CI: 44.8–47.5) had evidence of a used latrine. Nine districts had a prevalence of TF below the elimination threshold of 5%. In hyperendemic areas, 3–5 years of implementation of SAFE is insufficient to achieve trachoma elimination as a public health problem; additional years of SAFE and several rounds of TIS will be required before trachoma is eliminated.

Genomics of OcularChlamydia trachomatisafter 5 years of SAFE interventions for trachoma in Amhara, Ethiopia

“…3,24 Briefly, a multi-stage cluster randomized methodology was used, whereby clusters (villages) were selected using a population proportional to estimated size method, and within a cluster, a modified segmentation approach was used to randomly select segments of 30 to 40 households. 3 After enumerating all residents, present and consented residents were examined for trachoma based on the WHO simplified methodology. 25 Trained and certified trachoma graders used x2·5 magnification and adequate light.…”

“…As part of the SAFE strategy in Amhara National Regional State, Ethiopia, the Trachoma Control Program distributed over 124 million doses of antibiotic between 2007 and 2015. 3 Both administrative and self-reported coverage have demonstrated treatment coverage in the region to be close to or above the WHO recommended minimum threshold of 80%. [3][4][5] During this time, the program also provided village-based and school-based health education and assisted in the construction of latrines as part of the F and E components of SAFE.…”

“…3 Both administrative and self-reported coverage have demonstrated treatment coverage in the region to be close to or above the WHO recommended minimum threshold of 80%. [3][4][5] During this time, the program also provided village-based and school-based health education and assisted in the construction of latrines as part of the F and E components of SAFE. 3 Despite an average of 5 years of these interventions, trachoma remained hyperendemic in many districts, and a considerable level of Ct infection was evident throughout the region.…”

“…[3][4][5] During this time, the program also provided village-based and school-based health education and assisted in the construction of latrines as part of the F and E components of SAFE. 3 Despite an average of 5 years of these interventions, trachoma remained hyperendemic in many districts, and a considerable level of Ct infection was evident throughout the region. 3,6 Historically, Ct molecular epidemiology predominantly focused on ompA, 7 the gene encoding the major outer membrane protein.…”

“…3 Despite an average of 5 years of these interventions, trachoma remained hyperendemic in many districts, and a considerable level of Ct infection was evident throughout the region. 3,6 Historically, Ct molecular epidemiology predominantly focused on ompA, 7 the gene encoding the major outer membrane protein. More recently a number of multilocus sequence typing schemes with and without ompA have been used.…”