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The British Journal of Ophthalmology Oct 2018Trachoma is the leading infectious cause of blindness. Until recently, reliable data on the global extent of the disease, detailed plans for elimination, and... (Review)
Review
BACKGROUND
Trachoma is the leading infectious cause of blindness. Until recently, reliable data on the global extent of the disease, detailed plans for elimination, and government, donor and partner engagement were all inadequate.
METHODS
The trachoma community undertook a systematic, three-pronged strategy to map trachoma district by district, develop national-level trachoma elimination plans, and create a framework for governments, donors and partners to convene and coordinate in support of trachoma elimination. RESULT: There has been a frame-shift in internal and external perceptions of the global trachoma programme, from being an effort working towards disease control in focussed geographical areas, to one in the process of achieving worldwide disease elimination. Multiple factors contributed to the successful implementation of mapping, planning, and cross-sectional engagement of governments, partners and donors.
CONCLUSIONS
Elimination of trachoma is possible if the right combination of factors is in place. Planning for success is a critical first step. Some remaining challenges must still be addressed if the elimination targets are to be successfully attained.
Topics: Blindness; Disease Eradication; Eye Infections, Bacterial; Global Health; Humans; Prevalence; Risk Factors; Trachoma
PubMed: 29907634
DOI: 10.1136/bjophthalmol-2018-312476 -
Australian and New Zealand Journal of... Apr 2016Trachoma remains a major health concern in many remote Indigenous Australian communities, despite behaviour-modifying and biomedical strategies. This review aims to... (Review)
Review
OBJECTIVES
Trachoma remains a major health concern in many remote Indigenous Australian communities, despite behaviour-modifying and biomedical strategies. This review aims to examine the social epidemiology of trachoma in remote Indigenous communities and identify practical, sustainable strategies to alter the social determinants of the disease.
METHODS
A systematic search and critical review explored the proximal, intermediate and distal determinants of trachoma. The impact of swimming pools in remote Indigenous communities on trachoma and other infectious diseases was further examined.
RESULTS
Having a clean face was found to be protective for trachoma, but face-washing education programs have produced no significant benefits. Sanitation infrastructure in a community was the key determinant of facial cleanliness. Installation of swimming pools in remote Indigenous communities has been demonstrated to reduce the prevalence of several common childhood infections. However, minimal research has explored the impact of pools on trachoma rates.
CONCLUSIONS
The locally supported construction of pools in remote Indigenous communities may contribute to a decline in trachoma. A prospective, controlled trial is needed to test this hypothesis in endemic communities.
IMPLICATIONS
If validated by a well-designed study, pool construction may provide a much sought-after practical government strategy to combat trachoma in remote Indigenous communities.
Topics: Australia; Humans; Native Hawaiian or Other Pacific Islander; Public Health; Rural Health; Rural Population; Sentinel Surveillance; Trachoma
PubMed: 26123218
DOI: 10.1111/1753-6405.12396 -
The British Journal of Ophthalmology Aug 2021Although tremendous progress towards the 2020 goal of global elimination of trachoma as a public health problem has been made, it will not be achieved. Future targets...
BACKGROUND/AIMS
Although tremendous progress towards the 2020 goal of global elimination of trachoma as a public health problem has been made, it will not be achieved. Future targets are now being considered. One option is changing the goal to . We surveyed trachoma experts to assess beliefs related to trachoma eradication and determine perceived obstacles to achieving it.
METHODS
We conducted a survey at the beginning of a trachoma eradication session at the 2019 Coalition for Operational Research on Neglected Tropical Diseases meeting in National Harbor, Maryland, USA. We asked respondents what the most important goal of azithromycin mass drug administration was for trachoma (control, elimination of infection or eradication) and if and when they believed trachoma eradication would occur. We then asked what the biggest obstacles were to global eradication.
RESULTS
Fifty-six surveys were returned (95%). Most (91%) participants reported that the most important goal of azithromycin mass drug administration was control or elimination of infection, and 24% of participants reported that global eradication was not possible. Of the 76% who reported a year by which they believed trachoma could be eradicated, most fell between 2040 and 2050. Commonly cited barriers to global eradication included lack of surveillance tools to confirm eradication or monitor for infection recrudescence (32%) and lack of resources (23%).
CONCLUSIONS
Development of alternative indicators for trachoma surveillance and continued investment in trachoma programmes, particularly focused support in the most heavily affected populations, might increase enthusiasm for the feasibility of eradication.
Topics: Anti-Bacterial Agents; Azithromycin; Disease Eradication; Global Health; Health Care Surveys; Health Plan Implementation; Humans; Prevalence; Preventive Health Services; Trachoma; World Health Organization
PubMed: 32855161
DOI: 10.1136/bjophthalmol-2020-315815 -
The Lancet. Global Health Apr 2022Global elimination of trachoma as a public health problem was targeted for 2020. We reviewed progress towards the elimination of active trachoma by country and... (Review)
Review
BACKGROUND
Global elimination of trachoma as a public health problem was targeted for 2020. We reviewed progress towards the elimination of active trachoma by country and geographical group.
METHODS
In this retrospective analysis of national survey and implementation data, all countries ever known to be endemic for trachoma that had either implemented at least one trachoma impact survey shown in the publicly available Trachoma Atlas, or are in Africa were invited to participate in this study. Scale-up was described according to the number of known endemic implementation units and mass drug administration implementation over time. The prevalence of active trachoma-follicular among children aged 1-9 years (TF) from baseline, impact, and surveillance surveys was categorised and used to show programme progress towards reaching the elimination threshold (TF <5%) using dot maps, spaghetti plots, and boxplots.
FINDINGS
We included data until Nov 10, 2021, for 38 countries, representing 2097 ever-endemic implementation units. Of these, 1923 (91·7%) have had mass drug administration. Of 1731 implementation units with a trachoma impact survey, the prevalence of TF had reduced by at least 50% in 1465 (84·6%) implementation units and 1182 (56·4%) of 2097 ever-endemic implementation units had reached the elimination threshold. 2 years after reaching a TF prevalence below 5%, most implementation units sustained this target; however, 58 (56·3%) of 103 implementation units in Ethiopia showed recrudescence.
INTERPRETATION
Global elimination of trachoma as a public health problem by 2020 was not possible, but this finding masks the great progress achieved. Implementation units in high baseline categories and recrudescent TF might prolong the attainment of elimination of active trachoma. Elimination is delayed but, with an understanding of the patterns and timelines to reaching elimination targets and a commitment toward meeting future targets, global elimination can still be achieved by 2030.
FUNDING
None.
Topics: Child; Child, Preschool; Ethiopia; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Mass Drug Administration; Prevalence; Public Health; Retrospective Studies; Trachoma
PubMed: 35303459
DOI: 10.1016/S2214-109X(22)00050-X -
PloS One 2020The objectives of the study were to estimate the prevalence of different clinical signs of trachoma and identify possible factors associated with TF.
OBJECTIVES
The objectives of the study were to estimate the prevalence of different clinical signs of trachoma and identify possible factors associated with TF.
METHODOLOGY
Following the approval of the study protocol by the ethics committee, a cross-sectional study was conducted in Vaupés, a department of the Colombian Amazon, between the years 2012 and 2013 in two districts. Based on the records obtained from a standardized format for the clinical evaluation of the participants and the factors associated with follicular trachoma, an excel database was built and debugged, which was analyzed using IBM SPSS, Statistics Version 23 and Stata STATA (Version 14, 2015, StataCorp LLC, Texas, USA).
RESULTS
The records of 13,091 individuals was collected from 216 rural indigenous communities, of which 12,080 were examined (92.3%); 7,274 in the Western and 4,806 in the Eastern districts. A prevalence of trachomatous inflammation-follicular (TF) of 21.7% (n = 599; 95% CI 20.2-23.3) in the Western and 24.9% (n = 483; 95% CI 23.1-26.9) in the Eastern district was found in children aged 1 to 9 years. Regarding trachomatous trichiasis (TT), 77 cases were found, of which 14 belonged to the Western district (prevalence 0.3%, CI 95% 0.2-0.5) and 63 to the Eastern district (1.8%, CI 95% 1.4-2.4). Children aged between 1 to 9 years were significantly more likely to have TF when there was the presence of secretions on the face (OR: 3.2; 95% CI: 2.6-3.9).
CONCLUSIONS
Trachoma is a public health problem in Vaupés that requires the implementation of the SAFE strategy (S = Surgery, A = Antibiotics, F = Face Washing, E = Environment) in the Eastern and Western districts, for at least 3 consecutive years, in accordance with WHO recommendations.
Topics: Censuses; Child; Child, Preschool; Chlamydia trachomatis; Colombia; Female; Health Surveys; Humans; Infant; Male; Population Groups; Public Health; Risk Factors; Rural Population; Trachoma
PubMed: 32427995
DOI: 10.1371/journal.pone.0229297 -
The Lancet. Infectious Diseases Dec 2018Genital Chlamydia trachomatis infection is the most commonly diagnosed sexually transmitted infection. Trachoma is caused by ocular infection with C trachomatis and is... (Review)
Review
Genital Chlamydia trachomatis infection is the most commonly diagnosed sexually transmitted infection. Trachoma is caused by ocular infection with C trachomatis and is the leading infectious cause of blindness worldwide. New serological assays for C trachomatis could facilitate improved understanding of C trachomatis epidemiology and prevention. C trachomatis serology offers a means of investigating the incidence of chlamydia infection and might be developed as a biomarker of scarring sequelae, such as pelvic inflammatory disease. Therefore, serological assays have potential as epidemiological tools to quantify unmet need, inform service planning, evaluate interventions including screening and treatment, and to assess new vaccine candidates. However, questions about the performance characteristics and interpretation of C trachomatis serological assays remain, which must be addressed to advance development within this field. In this Personal View, we explore the available information about C trachomatis serology and propose several priority actions. These actions involve development of target product profiles to guide assay selection and assessment across multiple applications and populations, establishment of a serum bank to facilitate assay development and evaluation, and development of technical and statistical methods for assay evaluation and analysis of serological findings. The field of C trachomatis serology will benefit from collaboration across the public health community to align technological developments with their potential applications.
Topics: Chlamydia trachomatis; Data Interpretation, Statistical; Humans; Incidence; Lymphogranuloma Venereum; Serologic Tests; Trachoma
PubMed: 29983342
DOI: 10.1016/S1473-3099(18)30159-2 -
African Health Sciences Mar 2020Burundi is currently not meeting targets for elimination of trachoma and trichiasis by 2020 (GET2020). The recommended SAFE strategy (Surgery, antibiotics, face washing...
BACKGROUND
Burundi is currently not meeting targets for elimination of trachoma and trichiasis by 2020 (GET2020). The recommended SAFE strategy (Surgery, antibiotics, face washing and environmental improvement) is currently not fully implemented in many areas of Burundi. The existence of associations between face-washing, sanitation and trachoma prevalence remain undocumented.
METHODS
A convenience sample of 468 individuals from 117 households was drawn from attendees at trachoma clinics set up in four villages. Trachoma status, sex and age were recorded for all household members. Adult household members were surveyed about access to clean water and toilets, and knowledge of trachoma risk factors. Associations between cases of active trachoma per household and environmental risk factors were evaluated using generalised estimating equations.
RESULTS
The overall prevalence of active trachoma was 7.1% (95% CI 5.0-9.6%), but 19.5% (95% CI13.7-26.4%) in children under nine years old. 0.9% (95% CI 0.3-2.0) of participants had trichiasis. Access to a sanitary toilet more than halved the odds of active trachoma (OR 0.43, 95% CI 0.25-0.74%), however, participants did not appreciate this association.
CONCLUSION
Access to sanitation was associated with the occurrence of active trachoma. Future research should focus on whether improving knowledge of and access to sanitation might reduce trachoma prevalence.
Topics: Adolescent; Adult; Aged; Burundi; Chlamydia trachomatis; Cross-Sectional Studies; Environmental Health; Family Characteristics; Female; Humans; Hygiene; Male; Middle Aged; Neglected Diseases; Prevalence; Risk Factors; Sanitation; Skin Care; Trachoma; Water Supply; Young Adult
PubMed: 33402906
DOI: 10.4314/ahs.v20i1.23 -
Italian Journal of Pediatrics May 2022Trachoma is an infectious eye disease caused by Chlamydial trachomatis. It is a major health problem in poor nations, notably in Sub-Saharan Africa. Despite the severity...
BACKGROUND
Trachoma is an infectious eye disease caused by Chlamydial trachomatis. It is a major health problem in poor nations, notably in Sub-Saharan Africa. Despite the severity of the problem, there was a scarcity of data on trachoma prevalence and associated factors among school-aged children in Debre Tabor town following SAFE and MDA.
OBJECTIVES
The goal of this study was to determine the prevalence of active trachoma and its associated factors among school-aged children in Debre Tabor, Northwest Ethiopia, in 2019.
METHODS
A community-based cross-sectional study was used among school-aged children. Structured interview questionnaires, an observational checklist, and a physical examination were used to collect data from study participants who were chosen using a systematic random sampling procedure. IBM SPSS 20 was used to enter data, which was then transferred to IBM SPSS 20 for bivariate and multivariable logistic regression analysis.
RESULT
A total of 394 children aged 5-15 had been screened and took part in the study, with 9.9% (95% CI: 6.9, 12.7) testing positive for active trachoma. Having an unimproved larine type (AOR = 5.18; 95%CI: 1.96, 13.69), improper solid waste disposal (AOR = 3.026; 95%CI: 1.17, 7.8), family size greater than four (AOR = 3.4; 95%CI: 1.22, 9.49), not using soap for face washing (AOR = 4.48; 95%CI: 1.46, 13.72) and an unclean face of the child during examination (AOR = 23.93; 95%CI: 8.25, 69.38) were found to be significant predictors of active trachoma.
CONCLUSION
Active trachoma among school-age children was high compared to the WHO's definition of trachoma as a public health problem. A family size of four, poor solid waste management, an unimproved type of latrine, an unclean child's face, and not using soap when washing one's face were all significant predictors of active trachoma. Promotion of behavioral determinants through health education programs like keeping facial cleanliness by washing their child's face with soap, managing solid waste properly, and installing improved latrines to reduce active trachoma needs to be in place.
Topics: Child; Cross-Sectional Studies; Ethiopia; Humans; Infant, Newborn; Infant, Newborn, Diseases; Prevalence; Risk Factors; Soaps; Trachoma
PubMed: 35505439
DOI: 10.1186/s13052-022-01258-x -
Trachoma Prevention Practice and Associated Factors in Rural Lemo District, Southern Ethiopia, 2021.Ethiopian Journal of Health Sciences Jan 2023Trachoma is a leading cause of preventable blindness. It is more prevalent in areas where there is poor personal and environmental sanitation. Implementing a SAFE...
BACKGROUND
Trachoma is a leading cause of preventable blindness. It is more prevalent in areas where there is poor personal and environmental sanitation. Implementing a SAFE strategy will reduce the incidence of trachoma. The purpose of this study was to look into trachoma prevention practices and associated factors in rural Lemo, South Ethiopian communities.
METHODS
We conducted a community-based cross-sectional study in the rural Lemo district of south Ethiopia, covering 552 households, from July 1 - July 30, 2021. We used a multistage sampling technique. Seven Kebeles were selected using a simple random sampling method. Then, a systematic random sampling procedure with a five-interval size was applied to select the households.Our study assessed the association between the outcome variable and explanatory variables using binary and multivariate logistic regressions. The adjusted odds ratio was calculated, and variables with a p-value below 0.05 at the 95% confidence interval (CI) were considered statistically significant.
RESULTS
The study found that 59.6% (95% CI: 55.5%-63.7%) of participants had good trachoma prevention practices. Having a favorable attitude (odds ratio [AOR]: 1.91, 95% CI: 1.26-2.89), receiving health education (AOR: 2.16, 95% CI: 1.46-3.21), and obtaining water from a public pipe (AOR: 2.48, 95% CI: 1.09-5.66) were significantly associated with good trachoma prevention practice.
CONCLUSIONS
Fifty-nine percent of the participants had good prevention practices for trachoma. Health education, a favorable attitude, and a water source from public pipes were variables associated with good trachoma prevention practice. Improving water sources and disseminating health information are vital to increasing trachoma prevention practices.
Topics: Humans; Trachoma; Ethiopia; Cross-Sectional Studies; Risk Factors; Water; Prevalence
PubMed: 36890944
DOI: 10.4314/ejhs.v33i1.16 -
Advances in Parasitology 2016The World Health Organization has targeted the elimination of blinding trachoma by the year 2020. To this end, the Global Elimination of Blinding Trachoma (GET, 2020)...
The World Health Organization has targeted the elimination of blinding trachoma by the year 2020. To this end, the Global Elimination of Blinding Trachoma (GET, 2020) alliance relies on a four-pronged approach, known as the SAFE strategy (S for trichiasis surgery; A for antibiotic treatment; F for facial cleanliness and E for environmental improvement). Well-constructed and parameterized mathematical models provide useful tools that can be used in policy making and forecasting in order to help to control trachoma and understand the feasibility of this large-scale elimination effort. As we approach this goal, the need to understand the transmission dynamics of infection within areas of different endemicities, to optimize available resources and to identify which strategies are the most cost-effective becomes more pressing. In this study, we conducted a review of the modelling literature for trachoma and identified 23 articles that included a mechanistic or statistical model of the transmission, dynamics and/or control of (ocular) Chlamydia trachomatis. Insights into the dynamics of trachoma transmission have been generated through both deterministic and stochastic models. A large body of the modelling work conducted to date has shown that, to varying degrees of effectiveness, antibiotic administration can reduce or interrupt trachoma transmission. However, very little analysis has been conducted to consider the effect of nonpharmaceutical interventions (and particularly the F and E components of the SAFE strategy) in helping to reduce transmission. Furthermore, very few of the models identified in the literature review included a structure that permitted tracking of the prevalence of active disease (in the absence of active infection) and the subsequent progression to disease sequelae (the morbidity associated with trachoma and ultimately the target of GET 2020 goals). This represents a critical gap in the current trachoma modelling literature, which makes it difficult to reliably link infection and disease. In addition, it hinders the application of modelling to assist the public health community in understanding whether trachoma programmes are on track to reach the GET goals by 2020. Another gap identified in this review was that of the 23 articles examined, only one considered the cost-effectiveness of the interventions implemented. We conclude that although good progress has been made towards the development of modelling frameworks for trachoma transmission, key components of disease sequelae representation and economic evaluation of interventions are currently missing from the available literature. We recommend that rapid advances in these areas should be urgently made to ensure that mathematical models for trachoma transmission can robustly guide elimination efforts and quantify progress towards GET 2020.
Topics: Chlamydia trachomatis; Disease Eradication; Humans; Models, Theoretical; Neglected Diseases; Prevalence; Trachoma
PubMed: 27756453
DOI: 10.1016/bs.apar.2016.06.002