Risk factors for the progression of trachomatous scarring in a cohort of women in a trachoma low endemic district in Tanzania

Background Trachoma, a chronic conjunctivitis caused by Chlamydia trachomatis, is the leading infectious cause of blindness worldwide. Trachoma has been targeted for elimination as a public health problem which includes reducing trachomatous inflammation—follicular prevalence in children and reducing trachomatous trichiasis prevalence in adults. The rate of development of trachomatous trichiasis, the potentially blinding late-stage trachoma sequelae, depends on the rate of trachomatous scarring development and progression. Few studies to date have evaluated the progression of trachomatous scarring in communities that have recently transitioned to a low trachomatous inflammation—follicular prevalence. Methodology/Principal findings Women aged 15 and older were randomly selected from households in 48 communities within Kongwa district, Tanzania and followed over 3.5 years for this longitudinal study. Trachomatous inflammation—follicular prevalence was 5% at baseline and at follow-up in children aged 1–9 in Kongwa, Tanzania. 1018 women aged 15 and older had trachomatous scarring at baseline and were at risk for trachomatous scarring progression; 691 (68%) completed follow-up assessments. Photographs of the upper tarsal conjunctiva were obtained at baseline and follow-up and graded for trachomatous scarring using a previously published four-step severity scale. The overall cumulative 3.5-year progression rate of scarring was 35.3% (95% CI 31.6–39.1). The odds of TS progression increased with an increase in age in women younger than 50, (OR 1.03, 95% CI 1.01–1.05, p = 0.005) as well as an increase in the household poverty index (OR 1.29, 95% CI 1.13–1.48, p = 0.0002). Conclusions/Significance The 3.5-year progression of scarring among women in Kongwa, a formerly hyperendemic now turned hypoendemic district in central Tanzania, was high despite a low active trachoma prevalence. This suggests that the drivers of scarring progression are likely not related to on-going trachoma transmission in this district.

Active trachoma prevalence and its associated factors among children aged 1-9 years in rural residents of Lare District, Southwest Ethiopia

AIM: To determine the prevalence of active trachoma and its associated factors among children in Lare District, Southwest Ethiopia, 2019. METHODS: A community-based cross-sectional study was conducted. A total of 620 participants were recruited using a multi-stage sampling technique. A structured questionnaire, torch, and magnifying loupes were used for data collection. The data was entered into epidemiological information and exported to statistical package for social science version 20 for analysis. The bi-variable and multivariable Logistic regression analysis model was fitted to identify factors associated with active trachoma. Odds ratio with a 95%CI was used to show the direction and strength of association between independent and outcome variables. RESULTS: A total of 610 children participated in this study with a response rate of 98.39%. The prevalence of active trachoma was 132 (21.60%; 95%CI: 18.40-24.70). Family size being 6-9 (AOR=2.34; 95%CI: 1.14-5.02), presence of more than two preschool children in a house (AOR=2.04; 95%CI: 1.12-3.70), open field waste disposal system (AOR=2.62; 95%CI: 1.00-6.80) and type of latrine being uncovered (AOR=4.12; 95%CI: 2.00-8.51) were positively associated with active trachoma. On the other side, water consumption being 40-60 liters per day was a protective factor for active trachoma. CONCLUSION: The prevalence of active trachoma is high among children aged 1-9y in Lare District. Uncovered latrine, open field waste disposal system, family sizes of 6-9, and the presence of more than two preschool children in a house are associated with the occurrence of active trachoma. On the other side, water consumption of 40-60 liters is a protective factor.

Status of active trachoma infection among school children who live in villages of open field defecation: a comparative cross-sectional study

Background Although many efforts are made by different stakeholders, magnitude of active trachoma remains high among children in Ethiopia. Open field defecation was found to be the main source of active trachoma. However, comparative information on the effect of open field defecation and non-open field defecation on active trachoma is scarce in Ethiopia. Methods Comparative community based cross-sectional study was conducted from June 1–30, 2019 in Boricha and Dale districts to assess prevalence of active trachoma among primary school children. We have selected four primary schools purposively from two districts in Sidama. Study participants were selected by using simpe random sampling method. Data were collected through face to face interview, direct observation and ophthalmic examination. Logistic regression analysis was conducted to assess factors associated with active trachoma infection among primary school children. Adjusted Odds Ratios with 95% confidence interval and p-value less than 0.05 were computed to determine the level of significance. Result From the total of 746 study participants, only 701 study participants gave full response for interview questions making a response rate of 94%. The overall prevalence of active trachoma infection was 17.5% (95% CI, 14.1–20.8) among primary school students. Specifically, prevalence of active trachoma infection was 67.5% among children who lived in open field defecation villages, but it was 88.5% among school children who live in Non-ODF Kebeles. Factors like: Living in open field defecation Kebeles (AOR = 2.52, 95% CI, 1.5–4.1), having ocular discharge (AOR = 5.715, 95% CI, 3.4–9.4), having nasal discharge (AOR = 1.9, 95% CI, 1.06–3.39), and fly on the face (AOR = 6.47, 95% CI, 3.36–12.44) of children were positively associated with active trachoma infection. However, finger cleanness (AOR = 0.43, 95% CI, 0.21–0.9) was protective factor against active trachoma infection in this study. Conclusion Significant variation in prevalence of active trachoma infection among school children between open filed and non-open field defecation Kebeles was observed. Surprisingly, the prevalence in open field defecation was significantly lower than non-open field defecation. Hence, this indicates active trachoma infection highly depends on the hand hygiene than environmental sanitation. Educational campaign of hand hygiene should be enhanced in the community for school students.

The impact of access to water supply and sanitation on the prevalence of active trachoma in Ethiopia: A systematic review and meta-analysis

Background Trachoma is a worldwide infectious disease causing blindness. Trachoma continued as a public health problem in Ethiopia due to a lack of sanitation and inadequate prevention strategies. This study aimed to identify the impact of water supply and sanitation intervention on preventing active trachoma among children. Methods Systematic literature searches were performed from 4 international databases. The search involved articles published from January 1995 up to March 2019. The Cochran Q and I2 statistical tests were used to check heterogeneity among the studies. A random-effect meta-analysis was employed to determine the pooled estimates with a 95% confidence interval (CI). Data analysis was performed using the CMA V.3 and RevMan 5 software program, and the result of the systematic review was reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Findings Out of 211 studies screened for the analysis, only 29 studies were finally included in this systematic review and meta-analysis. The result revealed factors that are significantly associated with increased odds of active trachoma. Accordingly, households with no access to toilet facilities (odds ratio [OR]: 2.04, 95% CI: 1.75–2.38), no access to improved water (OR: 1.58, 95% CI: 1.27–1.96), and do not practice regular face washing for children (OR: 4.19, 95% CI: 3.02–5.81) have shown increased odds of active trachoma. Besides, the results show a higher prevalence of active trachoma among children who did not wash their faces with soap and frequently. Conclusions The study found strong evidence that lack of access to water, sanitation, and hygiene (WASH) was associated with increased prevalence of active trachoma among children. Therefore, a comprehensive and partnership-oriented program is needed to tackle the problem, but further study will be required to strengthen its implementation.

Prevalence and Factors Associated with Active Trachoma among Children 1-9 years of Age in the Catchment Population of Tora Primary Hospital, Silte zone, Southern Ethiopia, 2020

Background: Trachoma is the foremost cause of wide-reaching, preventable blindness. According to the World Health Organization report, nearly 1.3 million human beings are sightless due to trachoma, whereas about eighty-four million are hurt from active trachoma. A survey revealed that the countrywide prevalence of active trachoma among children aged 1–9 years in Ethiopia was 40.1%. Limited data are present regarding the study area; therefore, the aim of this study was to determine the magnitude and factors associated with active trachoma among 1-9 years of children in the catchment population of Tora Primary Hospital, South Ethiopia. Methods: A community-based cross-sectional study was performed on 589 children in a study place from February 15 to March 13, 2020. We used Epi data program version 3.1 and SPSS version 20 for data entry and analysis, respectively. Results: The overall occurrence of active trachoma in the catchment was 29.4% [CI=25.7, 33.12]. Of these cases, the trachomatous follicle (TF) 90.9%, TI (4.8%), and combination of TF/TI (4.2%) were found. Households’ educational status, frequency of face washing, knowledge about trachoma, source of water for washing purposes, and garbage disposal system were the independently associated factors of active trachoma. Conclusion: In this study area, the occurrence of active trachoma was high. Hence, it needs instant attention, such as constructing a responsiveness application in the community, inspiring children and parents to try out face washing, improving knowledge about trachoma and appropriate excreta disposal.

Stopping azithromycin mass drug administration for trachoma: A systematic review

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.

Molecular Detection of Chlamydia Trachomatis Associated with Ocular Infection among Children in Gadarif State-Sudan

Background: Trachoma is the leading cause of infectious blindness worldwide. Trachoma is endemic in parts of Africa, the middle east, and India. The disease is particularly problematic in particular Ethiopia and Sudan regions. Objectives :To detect Chlamydia trachomatis among active trachoma children using molecular technique in -Gadarif State- Sudan Methodology: A population-based prevalence study was conducted during the period from Nov 2016 to Nov 2017. A total of 318 children were surveyed; their ages range between 1 to 9 years old. The children's eyes were examined for trachoma follicles and trachoma inflammatory intense (TF, and TI). Samples were collected on Swabs from children clinically diagnosed as active trachoma for the DNA analysis, and collection was done from the tarsal conjunctival surface with a dacron polyester swab and with UTM media, DNA was extracted and amplified by molecular technique with Touchdown protocol and primers for C. trachomatis outer membrane protein complex B ( omcB). Data was collected by direct interviewing questionnaire; ethical approval was obtained from Ethical Research Committee -Al Neelain University Result: Out of the total 318 children, 83(26.1%) children were positive for the C trachomatis omc B gene; Sequencing was performed for both strands of omc B genes, found that the circulating strain in Sudan Gdarif state is similar genetically to the classical one registered in NCBI Conclusion: Chlamydia trachomatis is one of the causative agents of trachoma in Sudan, the circulating strain in Sudan Gdarif state is similar genetically to the classical one registered in NCBI Keywords: Chlamydia trachomatis- omc B genes- PCR- Trachoma- Sudan

Low prevalence of active trachoma and associated factors among children aged 1–9 years in rural communities of Metema District, Northwest Ethiopia: a community based cross-sectional study

Background Trachoma is an infectious disease of the eye caused by Chlamydia trachomatis and transmitted via contact with eye discharge from infected persons and leading to blindness worldwide. Children less than 9 years of age affected more seriously. The disease is common where access to water and sanitation are limited. Objective To determine the prevalence of active trachoma and associated factors among children aged 1–9 years in rural communities of Metema District, West Gondar Zone, Northwest Ethiopia. Method A community based cross-sectional study design was used to collect data from 792 children aged 1–9 years old in Metema district from April to May 2018. Multistage sampling technique was used to select the study participants. Pretested interviewer-administered structured questionnaire and eye examination using binocular loupe to differentiate trachoma cases was the data collection methods and tools. The bivariable and multivariable binary logistic regression model was employed for analysis. P-value < 0.05 was considered to declare statistical significance. Results A total of 752 children aged l-9 years were enrolled in this study with response rate of 94.9%. The overall prevalence of active trachoma among the study participants was 11.8% (95% CI, 9.5–13.9). Unprotected source of water (AOR = 4.7; 95% CI: 2.5–8.9), lower household water consumption (AOR = 2.8; 95% CI: 1.3–6.0), improper latrine utilization (AOR = 3.2; 95% CI: 1.5–6.7), and frequency of face washing once per day (AOR = 5.3; 95% CI: 1.2–26.6) were the factors significantly associated with active trachoma. Conclusion The current study revealed a lower overall prevalence of active trachoma (11.8%) than the WHO threshold prevalence (20%) used to declare it as a severe public health problem. All residents and health professional should collaborate on trachoma prevention by implementing the WHO SAFE strategy- surgery for trichiasis, antibiotics, facial cleanliness and environmental improvement for further trachoma elimination.

Low Prevalence of Active Trachoma and Associated Factors among Children aged 1–9 years in Rural Communities of Metema District, Northwest Ethiopia: A Community Based Cross-sectional Study

BackgroundTrachoma is an infectious disease of the eye caused by Chlamydia trachomatis and transmitted via contact with eye discharge from infected persons and leading to blindness worldwide. Children less than 9 years of age affected more seriously. The disease is common where access to water and sanitation are limited.ObjectiveTo determine the prevalence of active trachoma and associated factors among children aged 1–9 years in rural communities of Metema District, West Gondar Zone, Northwest Ethiopia.MethodA community based cross-sectional study design was used to collect data from 792 children aged 1–9 years old in Metema district from April to May 2018. Multistage sampling technique was used to select the study participants. Pretested interviewer-administered structured questionnaire and eye examination using binocular loupe to differentiate trachoma cases was the data collection methods and tools. The bivariable and multivariable binary logistic regression model was employed for analysis. P-value < 0.05 was considered to declare statistical significance.ResultsA total of 752 children aged l-9 years were enrolled in this study with response rate of 94.9%. The overall prevalence of active trachoma among the study participants was 11.8% (95 % CI, 9.5–13.9). Unprotected source of water (AOR = 4.7; 95% CI: 2.5–8.9), lower household water consumption (AOR = 2.8; 95% CI: 1.3-6.0), improper latrine utilization (AOR = 3.2; 95% CI: 1.5–6.7), and frequency of face washing once per day (AOR = 5.3; 95% CI: 1.2–26.6) were the factors significantly associated with active trachoma.ConclusionThe current study revealed a lower overall prevalence of active trachoma (11.8%) than the WHO threshold prevalence (20%) used to declare it as a severe public health problem. All residents and health professional should collaborate on trachoma prevention by implementing the WHO SAFE strategy- surgery for trichiasis, antibiotics, facial cleanliness and environmental improvement for further trachoma elimination.

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.