Implementing Preventive Chemotherapy through an Integrated National Neglected Tropical Disease Control Program in Mali

Neglected tropical diseases (NTDs) are a group of chronic infections that affect the poorest group of the populations in the world. There are currently five major NTDs targeted through mass drug treatment in the affected communities. The drug delivery can be integrated to deliver different drug packages as these NTDs often overlap in distribution. Mali is endemic with all five major NTDs. The integrated national NTD control program was implemented through the primary health care system using the community health center workers and the community drug distributors aiming at long-term sustainability. After a pilot start in three regions in 2007 without prior examples to follow on integrated mass drug administration, treatment for the five targeted NTDs was gradually scaled up and reached all endemic districts by 2009, and annual drug coverage in the targeted population has since been maintained at a high level for each of the five NTDs. Around 10 million people received one or more drug treatments each year since 2009. The country is on the way to meet the national objectives of elimination or control of these diseases. The successes and lessons learned in Mali are valuable assets to other countries looking to start similar programs

Elimination of Active Trachoma after Two Topical Mass Treatments with Azithromycin 1.5% Eye Drops

Trachoma is the leading cause of infectious blindness worldwide, accounting for 1.3 million cases of blindness. Although it has disappeared in many regions of the world, trachoma is still endemic in Africa, Eastern Mediterranean, Latin America, Asia, and Australia. The WHO has currently set a target of 2020 for controlling trachoma to a low enough level that resulting blindness will not be a major public health concern. Topical tetracycline was for a long time the recommended treatment for active trachoma, but compliance to the regimen is extremely poor. Azithromycin has properties that make it an ideal treatment for Chlamydia trachomatis: high efficacy, intracellular accumulation, and a long tissue half-life. There is now a new mass treatment of trachoma by azithromycin 1.5% eye drops which is as effective as the oral route. In the test health district of Kolofata, Cameroon, the prevalence of trachoma among children dramatically decreased from 31% to less than 5% after 2 treatments. A third treatment was performed in January 2010. An epidemiological surveillance is implemented to see if this removal will be permanent. It also avoids misuse of oral azithromycin and the eye drops are directly treating the site of the infection

Where Do We Go from Here? Prevalence of Trachoma Three Years after Stopping Mass Distribution of Antibiotics in the Regions of Kayes and Koulikoro, Mali

Trachoma, a blinding bacterial disease, is targeted for elimination by 2020. To achieve the elimination target, the World Health Organization (WHO) recommends member states implement the SAFE strategy; surgery, mass administration of antibiotics, promotion of hygiene and facial cleanliness and water and sanitation as environmental improvements. We present results from evaluation surveys conducted in 2006 and 2009 from the regions of Kayes and Koulikoro, Mali. Prevalence of active trachoma in 2006 was below baseline intervention thresholds in all surveyed districts and the national program stopped antibiotic distribution. The prevalence of trachoma in 2009 remained well below levels in 1998. However, in 8 of 13 districts compared, the prevalence of active trachoma was higher in 2009 than 2006. Three years of antibiotic intervention did not equate in all districts to a sustained reduction of active trachoma. No surveillance activities were implemented after stopping interventions. Surgical interventions may have reduced the burden of blinding trachoma but there is an ongoing need for surgeries specifically targeting affected women. Four districts meet the WHO criteria for resuming district-wide mass antibiotic distribution. A community-by-community approach to elimination may be needed in other districts. The promotion of facial cleanliness and good hygiene behavior should be reintroduced

The geographical distribution and burden of trachoma in Africa.

BACKGROUND: There remains a lack of epidemiological data on the geographical distribution of trachoma to support global mapping and scale up of interventions for the elimination of trachoma. The Global Atlas of Trachoma (GAT) was launched in 2011 to address these needs and provide standardised, updated and accessible maps. This paper uses data included in the GAT to describe the geographical distribution and burden of trachoma in Africa. METHODS: Data assembly used structured searches of published and unpublished literature to identify cross-sectional epidemiological data on the burden of trachoma since 1980. Survey data were abstracted into a standardised database and mapped using geographical information systems (GIS) software. The characteristics of all surveys were summarized by country according to data source, time period, and survey methodology. Estimates of the current population at risk were calculated for each country and stratified by endemicity class. RESULTS: At the time of writing, 1342 records are included in the database representing surveys conducted between 1985 and 2012. These data were provided by direct contact with national control programmes and academic researchers (67%), peer-reviewed publications (17%) and unpublished reports or theses (16%). Prevalence data on active trachoma are available in 29 of the 33 countries in Africa classified as endemic for trachoma, and 1095 (20.6%) districts have representative data collected through population-based prevalence surveys. The highest prevalence of active trachoma and trichiasis remains in the Sahel area of West Africa and Savannah areas of East and Central Africa and an estimated 129.4 million people live in areas of Africa confirmed to be trachoma endemic. CONCLUSION: The Global Atlas of Trachoma provides the most contemporary and comprehensive summary of the burden of trachoma within Africa. The GAT highlights where future mapping is required and provides an important planning tool for scale-up and surveillance of trachoma control

Extraction extra capsulaire versus phacomanuelle sans sutures dans le traitement de la cataracte de l’adulte au CHU-IOTA.

Introduction: Treatment of cataract blindness is surgical to restore vision. The aim of this work wasto compare the PKA to the classic EEC in the surgical treatment of adult cataract in terms ofanatomical and functional results in our institute. Materials and methods: This was a cross-sectionalstudy of 333 operated eyes of cataract of the adult and followed for one month. The postoperativefunctional data and the causes of poor results were specified.Result: A total of 172 men (51.7%) and 161 women (48.3%) underwent cataract surgery. The meanage was 64.2 years. 61.26% of patients had visual acuity (≥3 / 10) in EEC compared with 65.28% inPKA. (21%) for EEC, and (15%) for PKA had poor visual acuity (<1/10). The proportion of patients withgood results increases with the best correction to 77.3% for EEC and 91.5% for PKA. The poor resultsclose to those of the WHO in both techniques (6.7%). EEC and (5.3%) PKA.The poor results were mainly related to pre-existing pathologies (6.6%) and astigmatism related tosurgery (7.1%). Conclusion: In order to achieve the objectives of "Vision 2020", within the frameworkof the fight against blindness, it is imperative to facilitate the popularization of the PKA throughout theAfrican subregion.Introduction : Le traitement de la cécité par cataracte est chirurgical permettant ainsi de restaurer lavision. Le but de ce travail était de comparer la phacomanuelle sans suture (PKA) à l’extraction extracapsulaire (EEC) classique dans le traitement chirurgical de la cataracte de l’adulte en terme derésultats anatomiques et fonctionnels dans notre institut. Matériels et méthodes : Il s’agissait d’uneétude transversale sur 333 yeux opérés de cataracte de l’adulte et suivis pendant un mois. Lesdonnées fonctionnelles postopératoires et les causes de mauvais résultats ont été précisées.Résultats : Au total 172 hommes (51,7%) et 161 femmes (48,3%) ont subi une chirurgie de lacataracte. L’âge moyen était de 64,2 ans. L’acuité visuelle était bonne (≥3/10) chez (61,26 %) de nospatients en EEC contre (65,28%) en PKA. En EEC, (21%) et (15%) pour la PKA avaient une mauvaiseacuité visuelle (<1/10). La proportion des patients avec de bons résultats augmente avec la meilleurecorrection à (77,3%) pour EEC et (91,5%) pour la PKA. Les mauvais résultats avoisinent ceux del’OMS dans les deux techniques (6,7%) EEC et (5,3%) PKA. Les mauvais résultats étaientprincipalement liés aux pathologies préexistantes (6,6%) et astigmatismes liés à la chirurgie (7,1%).Conclusion : Pour atteindre les objectifs de la « vision 2020 », dans le cadre de la lutte contre la cécité,il est impératif de faciliter la vulgarisation de la PKA dans toute la sous-région africaine

A novel electronic data collection system for large-scale surveys of neglected tropical diseases

BACKGROUND: Large cross-sectional household surveys are common for measuring indicators of neglected tropical disease control programs. As an alternative to standard paper-based data collection, we utilized novel paperless technology to collect data electronically from over 12,000 households in Ethiopia. METHODOLOGY: We conducted a needs assessment to design an Android-based electronic data collection and management system. We then evaluated the system by reporting results of a pilot trial and from comparisons of two, large-scale surveys; one with traditional paper questionnaires and the other with tablet computers, including accuracy, person-time days, and costs incurred. PRINCIPLE FINDINGS: The electronic data collection system met core functions in household surveys and overcame constraints identified in the needs assessment. Pilot data recorders took 264 (standard deviation (SD) 152 sec) and 260 sec (SD 122 sec) per person registered to complete household surveys using paper and tablets, respectively (P = 0.77). Data recorders felt a lack of connection with the interviewee during the first days using electronic devices, but preferred to collect data electronically in future surveys. Electronic data collection saved time by giving results immediately, obviating the need for double data entry and cross-correcting. The proportion of identified data entry errors in disease classification did not differ between the two data collection methods. Geographic coordinates collected using the tablets were more accurate than coordinates transcribed on a paper form. Costs of the equipment required for electronic data collection was approximately the same cost incurred for data entry of questionnaires, whereas repeated use of the electronic equipment may increase cost savings. CONCLUSIONS/SIGNIFICANCE: Conducting a needs assessment and pilot testing allowed the design to specifically match the functionality required for surveys. Electronic data collection using an Android-based technology was suitable for a large-scale health survey, saved time, provided more accurate geo-coordinates, and was preferred by recorders over standard paper-based questionnaires