Trachoma Mapping in Gombe State, Nigeria: Results of 11 Local Government Area Surveys.

PURPOSE: To determine the need or otherwise for establishment of a trachoma elimination program in Gombe State, Nigeria, by estimating the population-based prevalence of trachoma in each Local Government Area (LGA) of Gombe. METHODS: Using a multi-stage, systematic, random, and quasi-random sampling approach and Global Trachoma Mapping Project support, we selected 25 clusters in each LGA. In each cluster, we selected 25 households and all consenting residents aged 1 year and older were examined for trachomatous inflammation-follicular (TF) and trichiasis, using the World Health Organization simplified grading scheme. RESULTS: No LGA in Gombe State had a TF prevalence ≥5% in 1-9-year-olds. All LGAs had trichiasis prevalences above the elimination threshold and should be targeted for community-based delivery of trichiasis surgery. Only three LGAs had household-level improved wash water access of greater than 80%. Access to improved sanitation facilities was also poor as household access to improved sanitation facilities was above 80% in only one LGA. CONCLUSION: A trachoma program focused on delivery of trichiasis surgery is required in Gombe. Improvements in water and sanitation, through engagement with other sectors, are necessary

Prevalence of Trachoma in Katsina State, Nigeria: Results of 34 District-Level Surveys.

PURPOSE: To determine the local government area (LGA)-level prevalence of trachoma in all 34 LGAs of Katsina State. METHODS: A population-based prevalence survey was conducted in each LGA of Katsina State, using the Global Trachoma Mapping Project methodology. We used a 3-stage cluster random sampling strategy to select 25 households from each of 25 clusters. We examined all residents of selected households aged 1 year and older for the clinical signs of trachomatous inflammation-follicular (TF), trachomatous inflammation-intense and trichiasis, using the World Health Organization (WHO) simplified grading scheme. RESULTS: We examined 129,281 persons. Six LGAs had a TF prevalence ≥10%, and another six LGAs had a TF prevalence between 5% and 9.9%; all 12 require mass drug administration with azithromycin plus other interventions. The prevalence of trichiasis was ≥1.0% in 13 LGAs, and there is a need to perform trichiasis surgery in over 26,000 persons to reach targets set by the WHO for elimination of trichiasis. CONCLUSION: The prevalence of TF is generally low in Katsina state, but urgent steps must be taken to implement the full SAFE strategy (surgery, antibiotics, facial cleanliness, environmental improvement) in at least 12 LGAs while also stepping up efforts to provide community-based trichiasis surgery throughout the whole state, in order to make trachoma elimination by 2020 a reality

Prevalence of Trachoma in Bauchi State, Nigeria: Results of 20 Local Government Area-Level Surveys.

PURPOSE: To determine the prevalence of trachomatous inflammation - follicular (TF) and trichiasis in each of the 20 local government areas (LGAs) of Bauchi State, Nigeria. METHODS: We undertook a population-based prevalence survey in each LGA in Bauchi State, employing the Global Trachoma Mapping Project methodology. We used a 2-stage, systematic and quasi-random sampling strategy. Using probability proportional to size, we selected 25 clusters, in each of which 25 households were selected by random walk. All residents of selected households 1 year and older were examined for TF, trachomatous inflammation - intense, and trichiasis, using the World Health Organization simplified grading scheme. RESULTS: Only two LGAs in Bauchi State had TF prevalences in 1-9-year-olds over 5%, with none having TF prevalences of 10% or greater. Only one LGA had a trichiasis prevalence in adults below the elimination threshold; all the others had trichiasis at levels suggestive of public health significance. In all 20 LGAs, more than 60% of households were within 1 km of an improved source of water for hygiene. CONCLUSION: Efforts need to be made in Bauchi State to provide trichiasis surgery in order to avert trachomatous blindness. Water supplies needs to be sustained and good personal hygiene practices assured so that elimination of trachoma as a public health problem will be achieved and sustained

Prevalence of Trachoma in Niger State, North Central Nigeria: Results of 25 Population-Based Prevalence Surveys Carried Out with the Global Trachoma Mapping Project.

PURPOSE: To determine the prevalence of trachoma in each of the 25 local government areas (LGAs) of Niger State, Nigeria. METHODS: A population-based cross-sectional survey was conducted in each Niger State LGA between March and April 2014, as part of the Global Trachoma Mapping Project (GTMP). GTMP protocols were used in planning and conduct of the surveys. Using probability proportional to size, 25 clusters were selected; in each of these clusters, 25 households were enrolled for the survey. All residents aged 1 year and older were examined by GTMP-certified graders for trachomatous inflammation - follicular (TF) and trichiasis using the World Health Organization simplified grading scheme. Additionally, we collected data on household water and sanitation facilities. RESULTS: Only one LGA (Kontagora) had TF prevalence in 1-9-year-olds above 10%; one other LGA (Rafi) had TF prevalence between 5.0 and 9.9%. Six LGAs need trichiasis surgical services provided to achieve a prevalence of <1 case of trichiasis per 1000 total population. The proportion of households with access to improved water sources ranged from 23 to 100%, while household-level access to improved latrines ranged from 8 to 100% across the LGAs. CONCLUSION: The prevalence of trachoma is relatively low in most of Niger State. There is a need for community-based trichiasis surgical services in a small number of LGAs. The trachoma elimination program could engage water and sanitation agencies to augment access to improved water and sanitation facilities, for human rights reasons. Kontagora and Rafi need community-based interventions to reduce the prevalence of active trachoma

Prevalence of trachoma in Yemen: results of population-based prevalence surveys of 42 evaluation units in nine governorates.

PURPOSE: In suspected trachoma-endemic areas of Yemen, we sought to determine the prevalence of the sign trachomatous inflammation-follicular (TF) in children aged 1-9 years, and the potential individual and household risk factors for TF in that age group. We also sought to determine the prevalence of trichiasis in adults aged ≥15 years. METHODS: We conducted a cluster-sampled survey in each of 42 evaluation units (EUs) comprising 166 rural districts of nine Governorates (Adh Dhale'a, Al Hodeihah, Al Jawf, Hadramoot, Hajjah, Ibb, Lahj, Ma'rib, Taiz) using the Global Trachoma Mapping Project systems and methodologies. Fieldwork was undertaken from September 2013 to March 2015. Risk factors for TF in children aged 1-9 years were evaluated using multilevel random effects logistic regression. RESULTS: The TF prevalence in children aged 1-9 years was ≥10% in two EUs (7 districts) and 5-9.9% in six EUs (24 districts). In adults aged ≥15 years, trichiasis prevalence was ≥0.2% in five EUs (19 districts). Being older (within the 1-9-year age bracket), being male, living in a household with higher numbers of children, and living in a household that reported the use of open defecation, were each independently associated with higher odds of TF. CONCLUSIONS: These surveys provided baseline data to enable planning for trachoma elimination. The World Health Organization Alliance for the Global Elimination of Trachoma by 2020 stands ready to assist Yemen once security considerations permit further surveys and implementation of control activities

Impact Survey Results after SAFE Strategy Implementation in 15 Local Government Areas of Kebbi, Sokoto and Zamfara States, Nigeria.

PURPOSE: To determine prevalence of trachoma after interventions in 15 local government areas (LGAs) of Kebbi, Sokoto and Zamfara States, Nigeria. METHODS: A population-based impact survey was conducted in each LGA using Global Trachoma Mapping Project (GTMP) protocols. In each LGA, 25 villages were selected, except in Arewa LGA, where we selected 25 villages from each of four subunits to obtain finer-resolution prevalence information. Villages were selected with probability proportional to size. In each village, 25 households were enrolled and all consenting residents aged ≥1 year were examined by GTMP-certified graders for trachomatous inflammation-follicular (TF) and trachomatous trichiasis (TT). Information on sources of household water and types of sanitation facilities used was collected through questioning and direct observation. RESULTS: The number of households enrolled per LGA ranged from 623 (Kware and Tangaza) to 2488 (Arewa). There have been marked reductions in the prevalence of TF and TT since baseline surveys were conducted in all 15 LGAs. Eight of the 15 LGAs have attained TF prevalences <5% in children, while 10 LGAs have attained TT prevalences <0.2% in persons aged ≥15 years. Between 49% and 96% of households had access to water for hygiene purposes within 1 km of the household, while only 10-59% had access to improved sanitation facilities. CONCLUSION: Progress towards elimination of trachoma has been made in these 15 LGAs. Collaboration with water and sanitation agencies and community-based trichiasis surgery are still needed in order to eliminate trachoma by the year 2020

Cost comparison between previous PDA system and LINKS.

<p>Cost comparison between previous PDA system and LINKS.</p

Implementation of LINKS system from June 2011–Aug 2013.

<p>Implementation of LINKS system from June 2011–Aug 2013.</p

Interview results.

<p>Interview results.</p