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Frontiers in Public Health 2022Trachoma, caused by ocular infection with , is a neglected tropical disease that can lead to blinding pathology. Current trachoma control programmes have successfully...
BACKGROUND
Trachoma, caused by ocular infection with , is a neglected tropical disease that can lead to blinding pathology. Current trachoma control programmes have successfully used mass drug administration (MDA) with azithromycin to clear infection and reduce transmission, alongside promoting facial cleanliness for better personal hygiene and environmental improvement. In areas of low-trachoma endemicity, the relationship between infection and trachomatous disease weakens, and non-chlamydial bacteria have been associated with disease signs.
METHODS
We enrolled a cohort of children aged 6-10 years from three adjacent trachoma endemic villages in Kilimanjaro and Arusha regions, Northern Tanzania. Children were divided into four clinical groups based on the presence or absence of ocular infection and clinical signs of trachomatous papillary inflammation (TP). To determine the impact of treatment on the ocular microbiome in these clinical groups, we performed V4-16S rRNA sequencing of conjunctival DNA from children 3-9 months pre-MDA ( = 269) and 3 months post-MDA ( = 79).
RESULTS
PCR-negative, no TP children had the highest pre-MDA ocular microbiome alpha diversity, which was reduced in infected children and further decreased in those with TP. Pre-MDA, and were associated with infection with and without concurrent TP, while was increased in those with TP in the absence of current infection. Post-MDA, none of the studied children had ocular infection or TP. MDA increased ocular microbiome diversity in all clinical groups, the change was of greater magnitude in children with pre-MDA TP. MDA effectively reduced the prevalence of disease causing pathogenic non-chlamydial bacteria, and promoted restoration of a normal, healthy conjunctival microbiome.
CONCLUSION
We identified as a non-chlamydial bacterium associated with the clinical signs of TP. Further investigation to determine its relevance in other low-endemicity communities is required. MDA was shown to be effective at clearing infection and other non-chlamydial ocular pathogens, without any detrimental longitudinal effects on the ocular microbiome. These findings suggest that azithromycin MDA may be valuable in trachoma control even in populations where the relationship between clinical signs of trachoma and the prevalence of current ocular infection has become dissociated.
Topics: Child; Humans; Trachoma; Azithromycin; Mass Drug Administration; Tanzania; RNA, Ribosomal, 16S; Anti-Bacterial Agents; Chlamydia trachomatis; Conjunctiva; Microbiota
PubMed: 36324475
DOI: 10.3389/fpubh.2022.1015714 -
PLoS Neglected Tropical Diseases Feb 2023Trachoma is the leading infectious cause of blindness. To reduce transmission, water, sanitation, and hygiene (WaSH) improvements are promoted through a comprehensive...
BACKGROUND
Trachoma is the leading infectious cause of blindness. To reduce transmission, water, sanitation, and hygiene (WaSH) improvements are promoted through a comprehensive public health strategy. Evidence supporting the role of WaSH in trachoma elimination is mixed and it remains unknown what WaSH coverages are needed to effectively reduce transmission.
METHODS/FINDINGS
We used g-computation to estimate the impact on the prevalence of trachomatous inflammation-follicular among children aged 1-9 years (TF1-9) when hypothetical WaSH interventions raised the minimum coverages from 5% to 100% for "nearby" face-washing water (<30 minutes roundtrip collection time) and adult latrine use in an evaluation unit (EU). For each scenario, we estimated the generalized prevalence difference as the TF1-9 prevalence under the intervention scenarios minus the observed prevalence. Data from 574 cross-sectional surveys conducted in 16 African and Eastern Mediterranean countries were included. Surveys were conducted from 2015-2019 with support from the Global Trachoma Mapping Project and Tropical Data. When modeling interventions among EUs that had not yet met the TF1-9 elimination target, increasing nearby face-washing water and latrine use coverages above 30% was generally associated with consistent decreases in TF1-9. For nearby face-washing water, we estimated a ≥25% decrease in TF1-9 at 65% coverage, with a plateau upon reaching 85% coverage. For latrine use, the estimated decrease in TF1-9 accelerated from 80% coverage upward, with a ≥25% decrease in TF1-9 by 85% coverage. Among EUs that had previously met the elimination target, results were inconclusive.
CONCLUSIONS
Our results support Sustainable Development Goal 6 and provide insight into potential WaSH-related coverage targets for trachoma elimination. Targets can be tested in future trials to improve evidence-based WaSH guidance for trachoma.
Topics: Child; Adult; Humans; Infant; Trachoma; Sanitation; Water; Cross-Sectional Studies; Hygiene; Prevalence
PubMed: 36780437
DOI: 10.1371/journal.pntd.0011103 -
Bulletin of the World Health... 1998
Topics: Global Health; Humans; Infection Control; Trachoma
PubMed: 10063695
DOI: No ID Found -
Proceedings of the Royal Society of... Nov 1972
Topics: Child, Preschool; Chlamydia; Conjunctivitis, Inclusion; Cornea; Humans; Hygiene; Infant, Newborn; Infant, Newborn, Diseases; Keratoconjunctivitis; Tetracycline; Trachoma
PubMed: 4642019
DOI: No ID Found -
BMJ (Clinical Research Ed.) Jul 2001
Meta-Analysis
Topics: Anti-Bacterial Agents; Child; Child, Preschool; Chlamydia trachomatis; Developing Countries; Humans; Hygiene; Infant; Insecticides; Randomized Controlled Trials as Topic; Trachoma
PubMed: 11473918
DOI: 10.1136/bmj.323.7306.218 -
Journal of Environmental and Public... 2020Trachoma is a neglected tropical disease which is the leading infectious cause of blindness in the world. Trachoma is one of the major health problems in Tigray Region,...
BACKGROUND
Trachoma is a neglected tropical disease which is the leading infectious cause of blindness in the world. Trachoma is one of the major health problems in Tigray Region, Northern Ethiopia. However, knowledge, attitudes, and practices about trachoma are not yet studied in depth. The objective of the study was to assess knowledge, attitudes, and practices on trachoma and its associated factors among rural communities in two districts of Tigay Region, Northern Ethiopia.
METHODS
A cross-sectional study was conducted in two districts of Tigray Region, Northern Ethiopia, from May 7-24, 2017. Data were collected on paper based, were entered into Epi Info version 3.5.1, and then exported to SPSS version 21 for analysis. Logistic regression analysis was done to identify factors associated with knowledge, attitudes, and practices.
RESULTS
In this study, a total of 194 respondents were included. The overall level of good knowledge, attitudes, and practices on trachoma was 51%, 49.5%, and 35.6%, respectively. Having ever received health education was significantly associated with good knowledge (adjusted odds ratio (AOR) = 4.10; 95% confidence interval (CI): 1.91-8.79) and attitudes (AOR = 2.10; 95% CI: 1.02-4.25). Moreover, good knowledge was associated with good practices on trachoma prevention and control (AOR = 2.86; 95% CI: 1.46-5.62).
CONCLUSION
Our study implies that areas with high burden of trachoma need to improve communities' knowledge, attitudes, and practices towards trachoma prevention and control in order to eliminate trachoma as a public health problem. Therefore, health education focused on SAFE strategy should be provided to increase knowledge and changing attitudes that contribute for good practices towards trachoma prevention and control among communities.
Topics: Adult; Cross-Sectional Studies; Ethiopia; Female; Health Education; Health Knowledge, Attitudes, Practice; Humans; Male; Middle Aged; Odds Ratio; Rural Population; Trachoma; Young Adult
PubMed: 32774392
DOI: 10.1155/2020/3270530 -
PLoS Neglected Tropical Diseases Jun 2022Globally, although effective prevention strategies and treatment are available, trachoma remains the major cause of infectious loss of sight. Trachoma is a predominant...
BACKGROUND
Globally, although effective prevention strategies and treatment are available, trachoma remains the major cause of infectious loss of sight. Trachoma is a predominant neglected disease in Ethiopia, and there is a 40.4% prevalence of active trachoma in the Goro district, Southeast Ethiopia. World Health Organization (WHO) recommends azithromycin mass treatment of at least 80% coverage to eliminate trachoma, even though the coverage of azithromycin mass treatment has not been studied yet in depth. Thus, this study aimed to assess the coverage and factors influencing azithromycin mass treatment uptake among adults in Goro district, Southeast Ethiopia.
METHODS
A community-based cross-sectional study was conducted from April 1st to April 30th, 2021 among all adults aged 15 years old and above. The multistage sampling technique was used to select 593 study respondents. A structured interviewer-administered questionnaire was used. Data were entered into Epi-Data version 3.1 and analyzed using SPSS version 23.0 software. Descriptive analysis and binary logistic regression analysis were used to analyze the data. Adjusted odds ratios (AOR) along with a 95% confidence interval (CI) and p-value < 0.05 were used to declare the strength and the significance of association, respectively.
RESULTS/PRINCIPAL FINDINGS
Five hundred and seventy eight study participants with a 97% response rate were included. The proportion of azithromycin mass drug administration coverage was found to be 75.80%; 95% CI: (72%-79%) in this study. Having better knowledge about trachoma (AOR = 2.36; 95% CI: 1.19-4.70), having better knowledge about azithromycin mass treatment (AOR = 4.19; 95% CI: 2.19-7.98), being educated (AOR = 7.20; 95% CI: 1.02-51.09), a campaign conducted at the quiet time (off-harvesting/planting season) (AOR = 6.23; 95% CI: 3.23-11.98), heard about the serious adverse effect from others (AOR = 0.25; 95% CI: 0.10-0.59) and being a volunteer to take azithromycin in the next campaign (AOR = 5.46; 95% CI: 2.76-10.79) were significantly associated with azithromycin mass drug administration coverage.
CONCLUSIONS/SIGNIFICANCE
The proportion of azithromycin mass treatment coverage of this study was lower than the WHO minimum target coverage. Thus, strengthening awareness, enhancing azithromycin mass trachoma treatment messages, and conducting campaigns off-season outside of harvesting and planting time should be prioritized in the future to meet the 2030 Sustainable Development Goal (SDG) target.
Topics: Adolescent; Adult; Azithromycin; Cross-Sectional Studies; Ethiopia; Humans; Infant, Newborn; Infant, Newborn, Diseases; Mass Drug Administration; Trachoma
PubMed: 35759466
DOI: 10.1371/journal.pntd.0010169 -
PloS One 2020Mass drug administration has implemented to reduce trachoma since 2001, however, trachoma is still the major public health problem in Amhara Region, Ethiopia. However,...
Prevalence and associated factors of active trachoma among children aged 1-9 years old in mass drug administration graduated and non-graduated districts in Northwest Amhara region, Ethiopia: A comparative cross-sectional study.
BACKGROUND
Mass drug administration has implemented to reduce trachoma since 2001, however, trachoma is still the major public health problem in Amhara Region, Ethiopia. However, credible evidence on the prevalence of trachoma and its associated factors after the implementation of mass drug administration is limited.
OBJECTIVE
To assess the prevalence and associated factors of active trachoma among children aged 1-9 years old in mass drug administration graduated and non-graduated districts in the Northwest Amhara Region.
METHODS
A comparative cross-sectional study was conducted from October to November, 2019. A stratified multistage random sampling was used to select 690 households having children aged 1-9 years. Data were collected using a pretested structured questionnaire. Data were entered into Epi-data version 3.1 and exported to SPSS version 20.0 for analysis. Bivariate and multivariable logistic regressions were employed to identify factors associated with active trachoma. Crude and adjusted odds ratios with 95% confidence interval were computed to assess the degree of association between the independent variables and active trachoma.
RESULTS
The overall prevalence of active trachoma was 8.3% (95% CI: 6.2% -10.5%) and showed a significant variation between graduated [3.5% (95% CI: 1.8% -5.6%)] and non-graduated [13% (95% CI: 9.7%-16.8%)] districts. Living in graduated districts (AOR = 7.39, 95% CI: 3.19, 17.09), fly presence in the house (AOR = 3.14, 95% CI: 1.43, 6.89), presence of more than two children in the family (AOR = 3.78, 95%CI: 1.79, 7.98), did not wash face daily (AOR = 6.31, 95% CI: 1.81, 21.98), did not use soap during face washing (AOR = 3.34, 95% CI: 1.37, 8.15), presence of sleep in eyes (AOR = 3.16, 95% CI: 1.42, 7.02) and presence of dirt on child face (AOR = 2.44, 95% CI: 1.08, 5.50) increased the odds of having active trachoma.
CONCLUSION
The prevalence of active trachoma was high in the study area and showed a significant variation between graduated and non-graduated districts with mass drug administration. Living in non-graduated districts, fly presence in the house, more than two children in a household, did not wash the face daily, did not use soap during face washing, presence of sleep in eyes, and dirt on the child's face were the significant predictors of active trachoma. Therefore, the identified modifiable factors are the area of intervention to reduce the burden of active trachoma.
Topics: Behavior; Child; Child, Preschool; Chlamydia trachomatis; Cross-Sectional Studies; Environment; Ethiopia; Family Characteristics; Female; Housing; Humans; Infant; Logistic Models; Male; Mass Drug Administration; Multivariate Analysis; Prevalence; Trachoma
PubMed: 33320864
DOI: 10.1371/journal.pone.0243863 -
PLoS Neglected Tropical Diseases Jul 2021The World Health Organization (WHO) recommends continuing azithromycin mass drug administration (MDA) for trachoma until endemic regions drop below 5% prevalence of...
The World Health Organization (WHO) recommends continuing azithromycin mass drug administration (MDA) for trachoma until endemic regions drop below 5% prevalence of active trachoma in children aged 1-9 years. Azithromycin targets the ocular strains of Chlamydia trachomatis that cause trachoma. Regions with low prevalence of active trachoma may have little if any ocular chlamydia, and, thus, may not benefit from azithromycin treatment. Understanding what happens to active trachoma and ocular chlamydia prevalence after stopping azithromycin MDA may improve future treatment decisions. We systematically reviewed published evidence for community prevalence of both active trachoma and ocular chlamydia after cessation of azithromycin distribution. We searched electronic databases for all peer-reviewed studies published before May 2020 that included at least 2 post-MDA surveillance surveys of ocular chlamydia and/or the active trachoma marker, trachomatous inflammation-follicular (TF) prevalence. We assessed trends in the prevalence of both indicators over time after stopping azithromycin MDA. Of 140 identified studies, 21 met inclusion criteria and were used for qualitative synthesis. Post-MDA, we found a gradual increase in ocular chlamydia infection prevalence over time, while TF prevalence generally gradually declined. Ocular chlamydia infection may be a better measurement tool compared to TF for detecting trachoma recrudescence in communities after stopping azithromycin MDA. These findings may guide future trachoma treatment and surveillance efforts.
Topics: Anti-Bacterial Agents; Azithromycin; Child; Child, Preschool; Chlamydia trachomatis; Female; Humans; Infant; Male; Mass Drug Administration; Randomized Controlled Trials as Topic; Trachoma
PubMed: 34237074
DOI: 10.1371/journal.pntd.0009491 -
The American Journal of Tropical... Feb 2023An estimated 30% of trachoma burden is borne by Ethiopia. Data on the prevalence of active trachoma and related factors in a pastoralist population are currently...
An estimated 30% of trachoma burden is borne by Ethiopia. Data on the prevalence of active trachoma and related factors in a pastoralist population are currently lacking. Additionally, no research has been conducted in the Oromia, Guji Zone of the Liben District. A community-based cross-sectional study was conducted among 538 children 1-9 years old in the pastoralist community of the Liben District from March 1 to April 30, 2021. A multistage systematic sampling method was applied to choose the sample. A structured questionnaire and WHO's trachoma grading scheme were used to identify active trachoma. Bivariate and multivariable logistic regression models were fitted to determine associated factors. An adjusted odds ratio with 95% confidence interval was calculated to decide the level of significance: 157 (29.2%) (95% CI: 24.9, 33.1) of children had clinical signs of active trachoma, 103 (66%) had trachomatous follicles, 41 (26%) had trachomatous intense, and 13 (8%) had both. There was an independent relationship between active trachoma and open defecation (adjusted odds ratio [AOR]: 2.75; 95% CI: 1.24, 6.09), defecating outside close to a house (AOR: 2.5; 95% CI: 1.07, 6.08), not having a latrine (AOR: 3.70; 95% CI: 1.60, 8.60), children who did not wash their faces with soap (AOR: 1.85; 95% CI: 1.10, 3.07), and being in a widowed household (AOR: 3.26; 95% CI: 1.57, 6.63). The study's findings revealed that about one-third of the children had clinical signs of trachoma. Research indicates that trachoma is a major concern for children in rural communities. Therefore, attention to trachoma control with antibiotics, facial hygiene, and environmental sanitation is strongly encouraged.
Topics: Child; Humans; Infant; Child, Preschool; Trachoma; Cross-Sectional Studies; Ethiopia; Prevalence; Risk Factors
PubMed: 36623488
DOI: 10.4269/ajtmh.22-0521