Collateral benefits arising from mass administration of azithromycin in the control of active trachoma in resource limited settings.

INTRODUCTION: The benefits of the use of antibiotics in the mass treatment for active trachoma and other diseases have been documented, but the secondary effects arising from such a programme have not been fully elucidated. The purpose of this study was to investigate the potential secondary benefits arising from the use of azithromycin in mass treatment of active trachoma in an economically challenged Kenyan nomadic community. METHODS: Health information reports for January 2005 to December 2010 were reviewed to determine the annual trends of infectious diseases in the two districts, Narok and Transmara. The year 2007 was considered as the baseline for mass drug administration (MDA). Odds ratios (OR) were used to describe the association. RESULTS: The mass distribution coverage in Narok was 83% in 2008, 74% in 2009 and 63% in 2010. The odds for malaria (OR = 1.13; 95% CI 1.12-1.14), diarrhoeal diseases (OR = 1.04; 95% CI 1.01-1.06), urinary tract infections (UTIs) (OR = 1.21; 95% CI 1.17-1.26), intestinal worms (OR, 4.98; 95% CI 4.68-5.3), and respiratory diseases other than pneumonia (OR, 1.15; 95% CI 1.13-1.16) were higher after three rounds of mass treatment, indicating a better outcome. Before the intervention, there was a reducing trend in the odds for respiratory diseases. In Transmara (control), there was an increase in odds for malaria, respiratory infections, UTIs and intestinal worms. The odds for diarrhoeal diseases, skin diseases and pneumonia decreased throughout the study period. CONCLUSION: Mass distribution of azithromycin may have contributed to the decrease in the prevalence of the respiratory infections in Narok District

Knowledge, practices and perceptions of trachoma and its control among communities of Narok County, Kenya

© 2016 The Author(s). Background: Trachoma is the leading infectious cause of blindness in the world. It is commonly found in cultural groups with poor hygiene. Trachoma control includes Surgery, Antibiotics, Facial cleanliness and Environmental Improvement (SAFE). Potentially blinding and active trachoma are monitored using trachomatous trichiasis (TT) in adults and trachoma inflammation-follicular (TF) in children aged 1-9 years respectively. A cross-sectional study to assess the knowledge, practices and perceptions of trachoma and its control was conducted in the endemic communities in Narok County. Methods: Qualitative methods were used for data collection. Using purposive sampling, 12 focus group discussions (FGDs) with single sex adult and young men and women groups of homogenous characteristics, 12 key informant interviews with opinion leaders and 5 in-depth interviews (IDIs) with trichiasis patients and 6 with persons who have undergone trichiasis surgery were conducted. Data was audio recorded, transcribed, coded and analyzed manually by study themes; knowledge, practices and perceptions of trachoma transmission, infection signs, prevention and control. Results: Majority of the community members had knowledge of trachoma and its transmission. The practices that contributed to transmission of infection included: failure to wash faces and bathe regularly, sharing of water basins and towels for face washing, traditional methods of trachoma treatment and dirty household environment. Due to socio-cultural perceptions, toilets were unacceptable and use of bushes for human waste disposal was common. Poor perceptions on disease susceptibility, flies on children's faces, latrine ownership and usage and separation of human and animal dwellings also played a role in the transmission of trachoma. Fear of loss of sight during surgery was a deterrent to its uptake and a desire to be able to see and take care of domestic animals promoted surgery uptake. Majority of the community members were appreciative of Mass Drug Administration (MDA) though side effect such as vomiting and diarrhoea were reported. Conclusion: Poor practices and related socio-cultural perceptions are important risk factors in sustaining trachoma infection and transmission. Community members require health education for behavior change and awareness creation about surgery, MDA and its potential side effects for elimination of trachoma in Narok County, Kenya. Trial registration: KEMRI SSC 2785. Registered 2 September 2014

Use of validated community-based trachoma trichiasis (TT) case finders to measure the total backlog and detect when elimination threshold is achieved: a TT methodology paper.

INTRODUCTION: The World Health Organization recommends TT surveys to be conducted in adults aged 15+ years (TT 15 survey) and certifies elimination of TT as a public health problem when there is less than 1 unknown case per 1,000 people of all ages. There is no standard survey method to accurately confirm this elimination prevalence threshold of 0.1% because rare conditions require large and expensive prevalence survey samples. The aim of this study was to develop an accurate operational research method to measure the total backlog of TT in people of all ages and detect when the elimination threshold is achieved. METHODS: Between July to October 2016, an innovative Community-based, Mapping, Mop-up and Follow-up (CMMF) approach to elimination of TT as a public health problem was developed and tested in Esoit, Siana, Megwara and Naikara sub-locations in Narok County in Kenya. The County had ongoing community-based TT surgical camps and case finders. TT case finders were recruited from existing pool of Community health volunteers (CHV) in the Community Health Strategy Initiative Programme of the Ministry of Health. They were trained, validated and supervised by experienced TT surgeons. A case finder was allocated a population unit with 2 to 3 villages to conduct a de jure pre-survey census, examine all people in the unit and register those with TT (TT all survey). Identified cases were confirmed by TT surgeons prior to surgery. Operated patients were reviewed at 1 day, 2 weeks and 3-6 months. The case finders will also be used to identify and refer new and recurrent cases. People with other eye and medical conditions were treated and referred accordingly. Standardised data collection and computer based data capture tools were used. Case finders kept registers with details of all persons with TT, those operated and those who refused to be operated (refusals). These details informed decision and actions on follow-up and counselling. Progress towards achievement of elimination threshold was assessed by dividing the number of TT cases diagnosed by total population in the population unit multiplied by 1,000. RESULTS: Narok County Government adopted both the CMMF approach and TT all survey method. All persons in 4,784 households in the four sub-locations were enumerated and examined. The total population projection was 29,548 and pre-survey census 22,912 people. Fifty-three cases of TT were diagnosed. The prevalence was 0.23% and this is equivalent to 2.3 cases per thousand population of all ages. Prior to this study, the project required to operate on at least 30 cases (excess cases) to achieve the elimination threshold of 1 case per 1000 population. CONCLUSION: The total backlog of TT was confirmed and the project is now justified to lay claim of having eliminated TT as a public health problem in the study area. TT all method may not be appropriate in settings with high burden of TT. Nomadic migrations affect estimation of population size. Non-trachomatous TT could not be ruled-out

Adapting clinical practice guidelines for diabetic retinopathy in Kenya: process and outputs.

BACKGROUND: The use of clinical practice guidelines envisages augmenting quality and best practice in clinical outcomes. Generic guidelines that are not adapted for local use often fail to produce these outcomes. Adaptation is a systematic and rigorous process that should maintain the quality and validity of the guideline, while making it more usable by the targeted users. Diverse skills are required for the task of adaptation. Although adapting a guideline is not a guarantee that it will be implemented, adaptation may improve acceptance and adherence to its recommendations. METHODS: We describe the process used to adapt clinical guidelines for diabetic retinopathy in Kenya, using validated tools and manuals. A technical working group consisting of volunteers provided leadership. RESULTS: The process was intensive and required more time than anticipated. Flexibility in the process and concurrent health system activities contributed to the success of the adaptation. The outputs from the adaptation include the guidelines in different formats, point of care instruments, as well as tools for training, monitoring, quality assurance and patient education. CONCLUSION: Guideline adaptation is applicable and feasible at the national level in Kenya. However, it is labor- and time -intensive. It presents a valuable opportunity to develop several additional outputs that are useful at the point of care

The “segment knockout” survey method for large trachoma-endemic districts

© 2012 Dr. Jefitha KarimurioPrevalence surveys are mandatory before new trachoma control projects are funded and existing ones continued. When a large administrative district with >200,000 people is surveyed as one trachoma intervention unit, the survey clusters are widely spaced and it is difficult to establish the distribution of the disease at the sub-district level with certainty. As a result, some trachoma-endemic areas in Kenya have been missed out and non-endemic areas included in mass antibiotic treatment. The other challenge is the large sample size required in standard trachomatous trichiasis (TT) surveys that include participants aged ≥15 years. The main objective of this study was to develop an effective and efficient survey method to justify administration of mass antibiotic treatment for active trachoma. The other objective was to establish the optimum lower age limit of TT survey participants, to ensure that the time required to complete a TT survey was the same as the time required to complete a TF survey, while ensuring that the sample was adequately representative of the TT backlog. The costs of surveys and administration of mass antibiotic treatment were determined for comparison of the standard and new survey methods. Data sets for previous surveys were re-analysed to calculate the optimum lower age limit of TT survey participants and correction factors to extrapolate the total backlog of TT. A “Trachoma Survey by Segment” (TSS) method was developed to justify and reduce the cost of mass antibiotic treatment. It was tested in Turkana, a large hyper-endemic district with 543,199 people and Narok, a meso-endemic district with 576,388 people. Each district was divided into five geographical areas (segments). A segment had a population of 100,000–200,000 people. Areas with similar risk of trachoma were aggregated in the same segment. The segments with 30% treated for 5 years. An efficient TT40 survey method was also developed where the backlog of TT was estimated in people ≥40 years old and correction factors used to extrapolate the total backlog. A TT40 survey required a smaller survey sample than a standard TT survey. The backlog correction factor for the lower age limit of 40 years was 1.1. In Turkana district 3,962 children aged 1-9 years were examined and the prevalence of TF in the whole district was 38.0% (95%CI: 32.2%-43.9%). If the survey was conducted using the standard survey by administrative district method the whole population would have been treated for 5 years. However, the TSS method revealed that two segments needed treatment for 3 years and three segments for 5 years. After mass treatment the areas will be re-surveyed to justify further treatment. In Narok district 3,998 children aged 1-9 years were examined and the prevalence of TF was 11.0% (95%CI: 8.0%-14.0%). The entire district had received three rounds of mass antibiotic treatment prior to this study. If this study was conducted by administrative district method, the whole population could have been treated for another three years. The TSS method identified three non-endemic segments which were excluded (knocked-out) from further treatment. In Turkana district 2,962 people ≥40 years were examined and 7.8% (95%CI: 6.8%-8.8%) had TT while in Narok 2,996 people ≥40 years were examined and 2.9% (95%CI: 2.2%-3.6%) had TT. All the segments in both districts needed TT surgical services. The cost of a survey by the administrative district method was $15,726 to$28,905, while by the TSS method it was $31,917 to$40,610 ($6,383 to$8,122 per segment). In 2009, the unit cost of administration of mass treatment was $0.20 to$0.42 per person treated. In Turkana district (hyper-endemic setting), the total cost of a survey and administration of mass treatment by the TSS method was $11,705 (1.7$168,275 (53.2%). It was concluded that the TSS is an effective trachoma survey method to identify the areas that need mass antibiotic treatment. For short term (3 years. The TT40 is an efficient trachoma survey method to determine the backlog of people with TT

Rapid Assessment of Avoidable Blindness Dataset: Kenya, Eastern, Embu (2007)

Anonymous participant level dataset including variables for visual acuity, spectacle use, lens status, cause of vision impairment, cataract surgical history, barriers to cataract surgery and population count data for five-year age-gender groups for males and females 50 years and olde

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