Twelve-Year Longitudinal Trends in Trachoma Prevalence among Children Aged 1–9 Years in Amhara, Ethiopia, 2007–2019

Abstract

Trachoma control in the Amhara region of Ethiopia, where all districts were once endemic, began in 2001 and attained full scale-up of the Surgery, Antibiotics, Facial cleanliness, and Environmental improvement (SAFE) strategy by 2010. Since scaling up, the program has distributed approximately 14 million doses of antibiotic per year, implemented village- and school-based health education, and promoted latrine construction. This report aims to provide an update on the prevalence of trachoma among children aged 1–9 years as of the most recent impact or surveillance survey in all 160 districts of Amhara. As of 2019, 45 (28%) districts had a trachomatous inflammation-follicular (TF) prevalence below the 5% elimination threshold. There was a statistically significant relationship between TF prevalence observed at the first impact survey (2010–2015) and eventual achievement of TF < 5% (2015–2019). Of the 26 districts with a first impact survey < 10% TF, 20 (76.9%) had < 5% TF at the most recent survey. Of the 75 districts with a first survey between 10% and 29.9% TF, 21 (28.0%) had < 5% TF at the most recent survey. Finally, among 59 districts ≥ 30% TF at the first survey, four (6.8%) had < 5% TF by 2019. As of 2019, 30 (18.8%) districts remained with TF ≥ 30%. Amhara has seen considerable reductions of trachoma since the start of the program. A strong commitment to the SAFE strategy coupled with data-driven enhancements to that strategy is necessary to facilitate timely elimination of trachoma as a public health problem regionally in Amhara and nationwide in Ethiopia.

Population-Based Prevalence of Ocular Chlamydia trachomatis Infection among Infants in the Trachoma Endemic Amhara Region, Ethiopia

“…7 Since 2012, each of these districts has received 5 additional years of interventions. 1 As these districts are geographically adjacent, and have similar epidemiology and treatment history, they were combined into one enumeration unit (EU).…”

“…Between September and October 2018, approximately 8 months since the last MDA, population-based trachoma impact surveys were conducted in these six districts using well-characterized methods. 1,7,8 Briefly, two-stage probability sampling was used whereby 30 clusters were selected using a probability proportional to estimated size method in the first stage, and segments of 30 households were randomly selected from each cluster in the second stage. 1 To determine the EU prevalence of C. trachomatis among infants, 410 infants 1-12 months were targeted for swabbing, which assumed a prevalence of 3% 6 3% based on earlier data from the region: a error of 0.05, design effect of 3.0, and 10% nonresponse rate.…”

“…1,7,8 Briefly, two-stage probability sampling was used whereby 30 clusters were selected using a probability proportional to estimated size method in the first stage, and segments of 30 households were randomly selected from each cluster in the second stage. 1 To determine the EU prevalence of C. trachomatis among infants, 410 infants 1-12 months were targeted for swabbing, which assumed a prevalence of 3% 6 3% based on earlier data from the region: a error of 0.05, design effect of 3.0, and 10% nonresponse rate. 9 Based on previous surveys, infants make up 1.9% of the population; therefore, approximately 70 infants per district and 420 per EU were expected.…”

“…8 Taylor linearization was used to estimate CIs for age-specific results, accounting for household and cluster level clustering. 1 Logistic regression was used to test for associations between age, sex, and trachoma outcomes while controlling for household and cluster level clustering.…”

“…80% reported population coverage and still have a persistently high prevalence of trachoma and its causative agent, ocular Chlamydia trachomatis infection. 1,2 Trachoma MDA programs deliver azithromycin to individuals ages $ 6 months and tetracycline eye ointment (TEO), twice daily for 6 weeks, to individuals age , 6 months. Although TEO has been shown to be effective against C. trachomatis, it has been demonstrated that compliance is poor.…”