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

Bamani, Sanoussi; King, Jonathan D.; Dembele, Mamadou Bakaye; Coulibaly, Famolo; Sankara, Dieudonné; Kamissoko, Yaya; Ting, Jim; Rotondo, Lisa; Emerson, Paul M.

doi:10.1371/journal.pntd.0000734

Cited by 20 publications

(27 citation statements)

References 24 publications

(25 reference statements)

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“…In such programmatic contexts, over 7 annual MDAs may be necessary to achieve the target. These findings are supported by other studies: in a programmatic context in Mali, three annual rounds of MDA were not sufficient at baseline prevalences of close to 30% [ 16 ], while seven to ten years of annual treatment were also suggested by a research study in a hyperendemic setting in Tanzania [ 9 ].…”

Section: Discussionsupporting

confidence: 76%

“…Even in relatively low-endemic regions, elimination may take more than three annual MDAs [ 14 , 15 ]. Three treatment rounds were also not sufficient for sustained elimination at roughly 30% baseline TF 1–9 prevalence [ 16 ]. Modeling suggests that where TF 1–9 prevalence is ≥50%, five years of annual treatment is likely not enough [ 17 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

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Mass Drug Administration for Trachoma: How Long Is Not Long Enough?

et al. 2015

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BackgroundBlinding trachoma is targeted for elimination by 2020 using the SAFE strategy (Surgery, Antibiotics, Facial cleanliness, and Environmental improvements). Annual mass drug administration (MDA) with azithromycin is a cornerstone of this strategy. If baseline prevalence of clinical signs of trachomatous inflammation – follicular among 1-9 year-olds (TF1-9) is ≥10% but <30%, the World Health Organization guidelines are for at least 3 annual MDAs; if ≥30%, 5. We assessed the likelihood of achieving the global elimination target of TF1-9 <5% at 3 and 5 year evaluations using program reports.Methodology/Principal FindingsWe used the International Trachoma Initiative’s prevalence and treatment database. Of 283 cross-sectional survey pairs with baseline and follow-up data, MDA was conducted in 170 districts. Linear and logistic regression modeling was applied to these to investigate the effect of MDA on baseline prevalence. Reduction to <5% was less likely, though not impossible, at higher baseline TF1-9 prevalences. Increased number of annual MDAs, as well as no skipped MDAs, were significant predictors of reduced TF1-9 at follow-up. The probability of achieving the <5% target was <50% for areas with ≥30% TF1-9 prevalence at baseline, even with 7 or more continuous annual MDAs.ConclusionsNumber of annual MDAs alone appears insufficient to predict program progress; more information on the effects of baseline prevalence, coverage, and underlying environmental and hygienic conditions is needed. Programs should not skip MDAs, and at prevalences >30%, 7 or more annual MDAs may be required to achieve the target. There are five years left before the 2020 deadline to eliminate blinding trachoma. Low endemic settings are poised to succeed in their elimination goals. However, newly-identified high prevalence districts warrant immediate inclusion in the global program. Intensified application of the SAFE strategy is needed in order to guarantee blinding trachoma elimination by 2020.

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Section: Discussionsupporting

confidence: 76%

Section: Introductionmentioning

confidence: 99%

Mass Drug Administration for Trachoma: How Long Is Not Long Enough?

et al. 2015

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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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“…The survey protocol used is consistent with several other trachoma prevalence surveys implemented in West and East Africa. [9][10][11][12][13][14][15]…”

Section: Samplingmentioning

confidence: 99%