Achieving trachoma control in Ghana after implementing the SAFE strategy

Yayemain, Daniel; King, Jonathan D.; Debrah, Oscar; Emerson, Paul M.; Aboe, Agatha; Ahorsu, Felix; Wanye, Seth; Ansah, Manfred Owusu; Gyapong, John; Hagan, Maria

doi:10.1016/j.trstmh.2009.02.007

Cited by 29 publications

(29 citation statements)

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“…Current data from the GAT confirm that countries with the highest burden of active trachoma and trichiasis remain in the Sahel and Savannah areas of Africa. Well established control programmes in several west and north African countries are likely to have had an impact on the burden of trachoma in the last decade, with successes in control activities documented in Burkina Faso, The Gambia [27], Ghana [28], [29], Mali [30]–[32], Mauritania [33] and Morocco and highlighted by comparison of current and historical maps available on the GAT website (www.trachomaatlas.org). The Gambia, Ghana and Morocco have now reported achievement of trachoma elimination targets and trachoma is believed to be no longer a public health concern in these countries.…”

Section: Discussionmentioning

confidence: 99%

The Geographical Distribution and Burden of Trachoma in Africa

et al. 2013

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BackgroundThere 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distribution and burden of trachoma in Africa.MethodsData assembly used structured searches of published and unpublished literature to identify cross-sectional epidemiological data on the burden of trachoma since 1980.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.ResultsAt 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.ConclusionThe 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.

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Section: Discussionmentioning

confidence: 99%

The Geographical Distribution and Burden of Trachoma in Africa

et al. 2013

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“…Reduction in TF 1–9 below 5% has been documented in other programs after SAFE implementation, but in those settings the prevalence of TF 1–9 at baseline was lower than in Amhara [17], [18]. TF 1–9 prevalence in South Sudan (also hyper-endemic for trachoma) was reduced to below 5% after high community uptake of SAFE interventions but this was observed only in one of four intervention sites [19].…”

Section: Discussionmentioning

confidence: 81%

Prevalence of Trachoma at Sub-District Level in Ethiopia: Determining When to Stop Mass Azithromycin Distribution

et al. 2014

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BackgroundTo eliminate blinding trachoma, the World Health Organization emphasizes implementing the SAFE strategy, which includes annual mass drug administration (MDA) with azithromycin to the whole population of endemic districts. Prevalence surveys to assess impact at the district level are recommended after at least 3 years of intervention. The decision to stop MDA is based on a prevalence of trachomatous inflammation follicular (TF) among children aged 1–9 years below 5% at the sub-district level, as determined by an additional round of surveys limited within districts where TF prevalence is below 10%. We conducted impact surveys powered to estimate prevalence simultaneously at the sub-district and district in two zones of Amhara, Ethiopia to determine whether MDA could be stopped.MethodologySeventy-two separate population-based, sub-district surveys were conducted in 25 districts. In each survey all residents from 10 randomly selected clusters were screened for clinical signs of trachoma. Data were weighted according to selection probabilities and adjusted for correlation due to clustering.Principal FindingsOverall, 89,735 residents were registered from 21,327 households of whom 72,452 people (80.7%) were examined. The prevalence of TF in children aged 1–9 years was below 5% in six sub-districts and two districts. Sub-district level prevalence of TF in children aged 1–9 years ranged from 0.9–76.9% and district-level from 0.9–67.0%. In only one district was the prevalence of trichiasis below 0.1%.Conclusions/SignificanceThe experience from these zones in Ethiopia demonstrates that impact assessments designed to give a prevalence estimate of TF at sub-district level are possible, although the scale of the work was challenging. Given the assessed district-level prevalence of TF, sub-district-level surveys would have been warranted in only five districts. Interpretation was not as simple as stopping MDA in sub-districts below 5% given programmatic challenges of exempting sub-districts from a highly regarded program and the proximity of hyper-endemic sub-districts.

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“…Achieving less than 5% TF at the district level is achievable and can be feasibly determined on a programmatic scale through the cluster random survey design as demonstrated in this study and in Ghana [29]. Not considering the differences in survey methodology, a district level prevalence of less than 5% TF after three continuous years of heavy antibiotic intervention did not equate in all districts to a sustained reduction of TF below 5%.…”

Section: Discussionmentioning

confidence: 82%

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

et al. 2010

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ObjectivesA national survey in 1997 demonstrated that trachoma was endemic in Mali. Interventions to control trachoma including mass drug administration (MDA) with azithromycin were launched in the regions of Kayes and Koulikoro in 2003. MDA was discontinued after three annual rounds in 2006, and an impact survey conducted. We resurveyed all districts in Kayes and Koulikoro in 2009 to reassess trachoma prevalence and determine intervention objectives for the future. In this paper we present findings from both the 2006 and 2009 surveys.MethodsPopulation-based cluster surveys were conducted in each of the nine districts in Koulikoro in 2006 and 2009, whilst in Kayes, four of seven districts in 2006 and all seven districts in 2009 were surveyed. Household members present were examined for clinical signs of trachoma.ResultsOverall, 29,179 persons from 2,528 compounds, in 260 clusters were examined in 2006 and 32,918 from 7,533 households in 320 clusters in 2009. The prevalence of TF in children aged 1–9 years in Kayes and Koulikoro was 3.9% (95%CI 2.9–5.0%, range by district 1.2–5.4%) and 2.7% (95%CI 2.3–3.1%, range by district 0.1–5.0%) respectively in 2006. In 2009 TF prevalence was 7.26% (95%CI 6.2–8.2%, range by district 2.5–15.4%) in Kayes and 8.19% (95%CI 7.3–9.1%, range by district 1.7–17.2%) in Koulikoro among children of the same age group. TT in adults 15 years of age and older was 2.37% (95%CI 1.66–3.07%, range by district 0.30–3.54%) in 2006 and 1.37% (95%CI 1.02–1.72%, range by district 0.37–1.87%) in 2009 in Kayes and 1.75% (95%CI 1.31–2.23%, range by district 1.06–2.49%) in 2006 and 1.08% (95%CI 0.86–1.30%, range by district 0.34–1.78%) in 2009 in Koulikoro.ConclusionsUsing WHO guidelines for decision making, four districts, Bafoulabe in Kayes Region; and Banamba, Kolokani and Koulikoro in Koulikoro Region, still meet criteria for district-wide implementation of the full SAFE strategy as TF in children exceeds 10%. A community-by-community approach to trachoma control may now be required in the other twelve districts. Trichiasis surgery provision remains a need in all districts and should be enhanced in six districts in Kayes and five in Koulikoro where the prevalence exceeded 1.0% in adults. Since 1997 great progress has been observed in the fight against blinding trachoma; however, greater effort is required to meet the elimination target of 2015.

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Achieving trachoma control in Ghana after implementing the SAFE strategy

Cited by 29 publications

References 12 publications

The Geographical Distribution and Burden of Trachoma in Africa

The Geographical Distribution and Burden of Trachoma in Africa

Prevalence of Trachoma at Sub-District Level in Ethiopia: Determining When to Stop Mass Azithromycin Distribution

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

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