Population-based rapid assessment of avoidable blindness survey in Sohag governorate in Egypt.

OBJECTIVES: To determine the prevalence and causes of blindness and vision impairment, and the coverage and quality of cataract surgical services, among population aged 50 years and older in Sohag governorate in Egypt. DESIGN: A population-based cross-sectional survey using two-stage cluster random sampling following the rapid assessment of avoidable blindness methodology. SETTING: A community-based survey conducted by six teams of ophthalmologists, assistants and local guides. Enrolment and examination were door-to-door in selected clusters. PARTICIPANTS: Using 2016 census data, 68 population units were randomly selected as clusters (of 60 people) with probability proportionate to population size. Anyone aged 50 years and older, residing in a non-institutional setting in a cluster for at least 6 months, was eligible to participate. PRIMARY AND SECONDARY OUTCOME MEASURES: The prevalence and causes of blindness and vision impairment. Secondary outcomes were CSC and effectiveness and participant-reported barriers to cataract surgery. RESULTS: Of 4078 participants enrolled, 4033 (98.9%) were examined. The age-adjusted and sex-adjusted prevalence of blindness, severe vision impairment and moderate vision impairment were 5.9% (95% CI 4.8% to 6.9%), 4.7% (95% CI 3.8% to 5.7%) and 18.9% (95% CI 16.8% to 21.0%), respectively. Cataract caused most of blindness (41.6%), followed by non-trachomatous corneal opacity (15.7%) and posterior segment diseases (14.5%). Cataract surgical coverage (CSC) for persons for visual acuity <3/60 was 86.8%, the proportion of cataract surgeries with poor visual outcome was 29.5% and effective CSC (eCSC) was 44.9%. eCSC was lower in women than men. The most frequently reported barrier to surgery was cost (51.5%). CONCLUSIONS: The prevalence of blindness in Sohag governorate is higher than districts in other middle-income countries in the region. CSC was high; however, women suffer worse quality-corrected CSC than men. The quality of cataract surgery needs to be addressed, while health system strengthening across government and private settings could alleviate financial barriers

Impact of a 10-Year Eye Care Program in Sokoto, Nigeria: Changing Pattern of Prevalence and Causes of Blindness and Visual Impairment.

BACKGROUND: This study was undertaken to ascertain the current magnitude and causes of blindness and visual impairment in persons aged 50 years and over and to assess the impact of a 10-year eye care program in Sokoto State, Nigeria. METHODS: A rapid assessment of avoidable blindness (RAAB) survey (in persons 50 years and over) was conducted in 2016. Participants were selected in Wurno health zone using a two-stage cluster randomized sampling with probability proportional to size. Operational definitions were based on RAAB and World Health Organization eye examination record definitions. Eye care program documents were reviewed and data from a baseline survey undertaken in 2005 were reanalyzed. RESULTS: A response of 89.1% (2405 of 2700 participants) was obtained in the 2016 survey. With available correction, the unadjusted prevalence of blindness was 7.7% (95% confidence interval [CI]: 6.4, 8.9). The odds of blindness were 1.8 times higher in females than males (95% CI: 1.3, 2.4; P < 0.001). Major causes of blindness were cataract (48.9%) corneal disease (20.1%), glaucoma (10.3%), and uncorrected refractive error/aphakia (8.7%). The age- and sex-adjusted prevalence of blindness has declined from 11.6% (95% CI: 7.4, 17.0) in 2005 to 6.8% (95% CI: 5.6, 8.0%) in 2016. CONCLUSION: The blindness prevalence is high, and the major causes are avoidable in the health zone. The findings suggest that investments in the program over the last 10 years might have led to almost a halving in the prevalence of blindness in th e population. However, the small sample size of persons 50+ years from Wurno zone in the 2005 survey necessitate caution when comparing the 2005 and the 2016 surveys

Prevalence of Trachoma following Implementation of the SAFE Strategy in Three Local Government Areas of Taraba State, North Eastern Nigeria

INTRODUCTION: In 2019–2020, one round of antibiotic mass drug administration (MDA) was implemented for trachoma elimination purposes in Donga, Gashaka, and Ussa local government areas (LGAs) of Taraba State, Nigeria, following baseline surveys in 2009 (Donga and Gashaka) and 2013–2014 (Ussa). Here, trachoma prevalence post-MDA in these three LGAs is reported. METHODS: In 2019 (Gashaka and Ussa) and 2020 (Donga), population-based, cross-sectional surveys were conducted following World Health Organization (WHO) guidance. A two-stage cluster sampling strategy was used. All residents of selected households aged ≥1 year were examined by Tropical Data-certified graders for trachomatous inflammation—follicular (TF) and trachomatous trichiasis (TT) using the WHO simplified trachoma grading scheme. Data on water, sanitation, and hygiene (WASH) access were also collected. RESULTS: A total of 1,883 households participated. From these households, 4,885 children aged 1–9 years were enumerated, and 4,866 (99.6%) examined. There were 5,050 eligible adults (aged ≥15 years) enumerated in the same households, of whom 4,888 (96.8%) were examined. Age-adjusted TF prevalence in children aged 1–9 years was 0.22% (95% CI: 0.00–0.65) in Donga, 0.0% in Gashaka, and 0.19% (95% CI: 0.00–0.44) in Ussa. The age- and gender-adjusted TT prevalence unknown to the health system in adults aged ≥15 years was 0.08% (95% CI: 0.00–0.19) in Donga, 0.02% (95% CI: 0.00–0.06) in Gashaka, and 0.10% (95% CI: 0.01–0.18) in Ussa. In Donga, Gashaka, and Ussa, respectively, 66%, 49% and 63% of households had access to an improved drinking water source, and 68%, 56% and 29% had access to an improved latrine. CONCLUSION: In all LGAs, the elimination thresholds for TF and TT unknown to the health system have been attained in the target age groups. These LGAs should be re-surveyed after 2 years to show that reductions in TF prevalence have been sustained in the absence of MDA. Health authorities should continue to improve WASH facilities to reduce the risk of later recrudescence

Prevalence of Trachoma in Kogi State, Nigeria: Results of four Local Government Area-Level Surveys from the Global Trachoma Mapping Project.

PURPOSE: To determine the prevalence of trachoma in four Local Government Areas (LGAs) of Kogi State, Nigeria. METHODS: In June 2014, we conducted population-based, cross-sectional surveys according to Global Trachoma Mapping Project (GTMP) protocols in selected LGAs of Kogi State. In each LGA, 25 clusters were selected with probability proportional to size. In each of these clusters, 25 households were enrolled for the survey. All residents of selected households aged ≥1 year were examined by GTMP-certified graders for trachomatous inflammation-follicular (TF) and trichiasis using the simplified trachoma grading scheme. Data on sources of household water and types of sanitation facilities were collected through questioning and direct observation. RESULTS: The age-adjusted TF prevalence in 1-9-year-olds ranged from 0.4% (95% CI 0.1-0.8%) in Bassa to 1.0% (95% CI 0.3-1.9%) in Omala. Across all four LGAs, only one case of trichiasis was found; this individual was in Omala, giving that LGA a trichiasis prevalence in individuals aged ≥15 years of 0.02% (95% CI 0.00-0.07%). Between 77 and 88% of households had access to water for hygiene purposes, while only 10-30% had access to improved sanitation facilities. CONCLUSION: Trachoma is not a public health problem in any of the 4 LGAs surveyed. There is, however, the need to increase access to adequate water and sanitation services to contribute to the health and social and economic well-being of these communities

Baseline Prevalence of Trachoma in 21 Local Government Areas of Adamawa State, North East Nigeria.

PURPOSE: To determine the prevalence of trachoma in each of the 21 local government areas (LGAs) of Adamawa State, Nigeria. METHODS: A population-based cross-sectional survey was conducted in each of the 21 LGAs of Adamawa State between 2017 and 2019. With the support of Tropical Data (TD), surveys were planned and implemented in accordance with World Health Organization (WHO) recommendations. A two-stage cluster sampling technique was used in each LGA, 25 or 30 clusters were selected with a probability of selection proportionate to cluster size, and in each of these clusters, 25 or 30 households were enrolled for the survey. All residents aged 1 year and older within selected households were examined by TD-certified graders for trachomatous inflammation - follicular (TF) and trachomatous trichiasis (TT) using the WHO simplified grading scheme. Additionally, data were collected on household water and sanitation access. RESULTS: All 21 LGAs had TF prevalence in 1-9-year-olds below 5%. The prevalence of TT unknown to the health system in people aged ≥15 years was ≥0.2% in three of the 21 LGAs. Access to improved water and sanitation facilities was <80% in the majority of the surveyed LGAs. Only 12 of the 21 LGAs had ≥50% household-level improved latrine access, and only Yola North had ≥80% household-level improved latrine access. CONCLUSION: There is no need for mass treatment with antibiotics for trachoma elimination purposes in any of these LGAs. There is a need for active TT case finding and provision of community-based TT surgical services in three LGAs. Furthermore, engagement with water and sanitation agencies is needed to augment access to improved water and sanitation facilities across the State; this will help to avoid the recrudescence of active trachoma in the State

Baseline Prevalence of Trachoma in 13 Local Government Areas of Borno State, Nigeria

PURPOSE: We set out to determine the baseline prevalence of trachoma in 13 Local Government Areas (LGAs) of Borno State, Nigeria. METHODS: A population-based cross-sectional survey was conducted in each of 13 LGAs from 2017 to 2019, with the support of Tropical Data (TD). World Health Organization (WHO)-recommended protocols were used. With a probability-proportional-to-size systematic sampling method, 25 villages were selected per LGA in 2017 and 30 villages per LGA in 2019; in each village, 25 households were enrolled for 2017 surveys, while 30 were enrolled for 2019 surveys. All present, consenting residents aged ≥1 year were examined by TD-certified graders for trachomatous inflammation—follicular (TF) and trachomatous trichiasis (TT) using the WHO simplified grading scheme. Additionally, we collected data on household-level access to water, sanitation and hygiene (WASH) facilities. RESULTS: One LGA (Magumeri) had TF prevalence in 1–9-year-olds ≥10%; two other LGAs (Monguno and Kaga) had TF prevalence between 5.0% and 9.9%. The prevalence of TT unknown to the health system was ≥0.2% in six LGAs. The proportion of households with access to improved water sources ranged from 30% (Kwaya Kusar) to 95% (Monguno); household-level access to improved latrines was lowest in Shani (7%) and highest in Maiduguri (95%). CONCLUSION: Active TT case finding and strengthening of TT surgical services are needed in six LGAs. Mass drug administration (MDA) of antibiotics is needed in three LGAs to reduce the prevalence of active trachoma to below elimination thresholds. The trachoma elimination programme should engage WASH agencies to augment access to improved WASH facilities

Prevalence of Trachoma and Access to Water and Sanitation in Benue State, Nigeria: Results of 23 Population-Based Prevalence Surveys.

PURPOSE: We sought to determine the prevalence of trachoma in each local government area (LGA) of Benue State, Nigeria. METHODS: Two-stage cluster sampling was used to conduct a series of 23 population-based prevalence surveys. LGAs were the evaluation units surveyed. In each LGA, 25 households were selected in each of 25 clusters, and individuals aged 1 year and above resident in those households were invited to be examined for trachoma. Data on access to water and sanitation were also collected at household level. RESULTS: A total of 91,888 people were examined from among 93,636 registered residents across the 23 LGAs. The LGA-level prevalence of trachomatous inflammation-follicular (TF) in 1-9 year olds ranged from 0.3% to 5.3%. Two LGAs had TF prevalences of 5.0-9.9%. The LGA-level prevalence of trichiasis in ≥15-year-olds ranged from 0.0% to 0.35%. Access to improved drinking water sources ranged from 0% in Gwer West to 99% in Tarka, while access to improved sanitation ranged from 1% in Gwer West to 92% in Oturkpo. CONCLUSION: There is a need for public health-level interventions against trachoma in three LGAs of Benue State

Prevalence of and risk factors for trachoma in Kwara state, Nigeria: Results of eight population-based surveys from the Global Trachoma Mapping Project.

PURPOSE: To determine the prevalence of and risk factors for trachoma in selected local government areas (LGAs) of Kwara State, Nigeria. METHODOLOGY: Population-based cross-sectional surveys were conducted in eight LGAs of Kwara State using Global Trachoma Mapping Project (GTMP) protocols. In each LGA, 25 villages were selected using probability-proportional-to-size sampling; 25 households were selected from each village using compact segment sampling. All residents of selected households aged ≥1 year were examined by GTMP-certified graders for trachomatous inflammation-follicular (TF) and trichiasis using the simplified trachoma grading scheme. Water, sanitation, and hygiene (WASH) data were also collected. RESULTS: A total of 28,506 residents were enumerated in 4769 households across the eight LGAs. TF prevalence in children aged 1-9 years ranged from 0.2% (95% CI 0.0-0.3%) to 1.3% (95% CI 0.7-2.1%), while trichiasis prevalence in persons ≥15 years was <0.2% in each LGA. Access to improved water source was the lowest in Edu (62%), while access to improved sanitation facilities was the lowest in Asa (6%) and the highest in Ilorin East (64%). Children aged 1-4 years had 0.63 (95% CI 0.40-0.99) times lower odds of having TF compared to children aged 5-9 years. Children in households with ≥5 resident 1-9-year-old children had 1.63 (95% CI 1.02-2.60) times greater odds of having TF compared to those in households with <5 resident children. CONCLUSION: Trachoma is not a public health problem in Kwara State. Provision of adequate water and sanitation services should be a priority here, as a foundation for the health of the population

Prevalence of trachoma in 13 Local Government Areas of Taraba State, Nigeria.

PURPOSE: The purpose of these surveys was to determine the prevalence of trachomatous inflammation-follicular (TF) in children aged 1-9 years and trichiasis prevalence in persons aged ≥15 years, in 13 Local Government Areas (LGAs) of Taraba State, Nigeria. METHODS: The surveys followed Global Trachoma Mapping Project (GTMP) protocols. Twenty-five households were selected from each of 25 clusters in each LGA, using two-stage cluster sampling providing probability of selection proportional to cluster size. Survey teams examined all the residents of selected households aged ≥1 year for the clinical signs TF, trachomatous inflammation-intense (TI) and trichiasis. RESULTS: The prevalence of TF in children aged 1-9 years in the 13 LGAs ranged from 0.0-5.0%; Ussa LGA had the highest prevalence of 5% (95%CI: 3.4-7.2). Trichiasis prevalence ranged from 0.0-0.8%; seven LGAs had trichiasis prevalences above the threshold for elimination. The backlog of trichiasis in the 13 LGAs (estimated combined population 1,959,375) was 3,185 people. There is need to perform surgery for at least 1,835 people to attain a trichiasis prevalence in each LGA of 80% of households with access to improved latrines. CONCLUSION: One of 13 LGAs requires antibiotic mass drug administration for active trachoma. Community-based trichiasis surgery needs to be provided in seven LGAs. There is a need to increase household-level access to improved washing water and latrines across the State

The Global Trachoma Mapping Project: Methodology of a 34-Country Population-Based Study.

PURPOSE: To complete the baseline trachoma map worldwide by conducting population-based surveys in an estimated 1238 suspected endemic districts of 34 countries. METHODS: A series of national and sub-national projects owned, managed and staffed by ministries of health, conduct house-to-house cluster random sample surveys in evaluation units, which generally correspond to "health district" size: populations of 100,000-250,000 people. In each evaluation unit, we invite all residents aged 1 year and older from h households in each of c clusters to be examined for clinical signs of trachoma, where h is the number of households that can be seen by 1 team in 1 day, and the product h × c is calculated to facilitate recruitment of 1019 children aged 1-9 years. In addition to individual-level demographic and clinical data, household-level water, sanitation and hygiene data are entered into the purpose-built LINKS application on Android smartphones, transmitted to the Cloud, and cleaned, analyzed and ministry-of-health-approved via a secure web-based portal. The main outcome measures are the evaluation unit-level prevalence of follicular trachoma in children aged 1-9 years, prevalence of trachomatous trichiasis in adults aged 15 + years, percentage of households using safe methods for disposal of human feces, and percentage of households with proximate access to water for personal hygiene purposes. RESULTS: In the first year of fieldwork, 347 field teams commenced work in 21 projects in 7 countries. CONCLUSION: With an approach that is innovative in design and scale, we aim to complete baseline mapping of trachoma throughout the world in 2015