Background: A number of suspected endemic districts with Trachoma have not been mapped in Malawi, and this contributes to delays for scaling up trachoma control activities. Objectives: To determine the prevalence of t...Background: A number of suspected endemic districts with Trachoma have not been mapped in Malawi, and this contributes to delays for scaling up trachoma control activities. Objectives: To determine the prevalence of trachoma and associated risk factors in one of the suspected endemic districts (Salima District) in central Malawi and to generate information to guide policy decisions. Methods: A population-based survey conducted in randomly selected clusters in Salima District (population 418,672), centralMalawi. Children aged 1-9 years and adults aged 15 and above were assessed for clinical signs of trachoma. Results: In total, 884 households were enumerated within 36 clusters. A total of 2765 persons were examined for ocular signs of trachoma. The prevalence of trachomatous inflammation, follicular (TF) among children aged 1-9 years was 17.1% (95% CI 14.9-19.4). The prevalence of trachoma trichiasis (TT) in women aged 15 years and above was 1.3% (CI 0.7-2.3), while the prevalence in men was zero. The presence of a dirty face and lack of sanitation were significantly associated with trachoma follicular (P < 0.001). Conclusion: Prevalence rate of trachoma follicles (TF) in Central Malawi exceeds the WHO guidelines for the intervention with mass antibiotic distribution (TF > 10%), and warrants the trachoma SAFE (Surgery, Antibiotics, Face washing and Environmental hygiene) control strategy to be undertaken in Salima District.展开更多
Background:In 2009 Ghana began to design a trachoma pre-validation surveillance plan,based on then-current WHO recommendations.The plan aimed to identify active trachoma resurgence and identify and manage trichiasis c...Background:In 2009 Ghana began to design a trachoma pre-validation surveillance plan,based on then-current WHO recommendations.The plan aimed to identify active trachoma resurgence and identify and manage trichiasis cases,through both active and passive surveillance approaches.This paper outlines and reviews the adaptations made by Ghana between 2011 and 2016.The assessment will provide a learning opportunity for a number of countries as they progress towards elimination status.Methods:A mixed methods approach was taken,comprising in-depth interviews and documents review.Between January and April 2016,20 in-depth interviews were conducted with persons involved in the operationalisation of the trachoma surveillance system from across all levels of the health system.A three-tier thematic coding framework was developed using a primarily inductive approach but also allowed for a more iterative approach,which drew on aspects of grounded theory.Results:During the operationalisation of the Ghana surveillance plan there were a number of adaptations(as compared to the WHO recommendations),these included:(i)Inclusion of surveillance of active trachoma in the passive surveillance approach,as compared to trichiasis alone.Issues with case identification,challenges in implementation coverage and a non-specific reporting structure hampered effectiveness;(ii)Random selection and increase in number of sites selected for the active surveillance component.This likely lacked the spatiotemporal power to be able to identify recrudescence in a timely manner;(iii)Targeted trichiasis door-to-door case searches,led by ophthalmic nurses.An effective methodology to identify trichiasis cases but resource intensive;(iv)A buddy system between ophthalmic nurses to support technical skills in an elimination setting where it is difficult to attain diagnostic and surgical skills,due to a lack of cases.The strategy did not take into account the loss of proficiency within experienced personnel.Conclusions:Ghana developed a comprehensive surveillance system that exceeded the WHO recommendations but issues with sensitivity and specificity likely led to an inefficient use of resources.Improved targeted surveillance strategies for identification of recrudescence and trichiasis case searches,need to be evaluated.Strategies must address the contextual changes that arise because of transmission decline,such as loss of surgical skills.展开更多
Background Soil-transmitted helminths(STH)affect approximately 1.5 billion people globally.The current STH control strategy is annual or twice-annual preventive chemotherapy,typically school-based deworming targeting ...Background Soil-transmitted helminths(STH)affect approximately 1.5 billion people globally.The current STH control strategy is annual or twice-annual preventive chemotherapy,typically school-based deworming targeting children and women of reproductive age.Mathematical modeling suggests that it may be possible to interrupt STH transmission through high-coverage community-wide mass drug administration(cMDA).DeWorm3 is a cluster randomized trial testing cMDA for prevalence reduction and transmission interruption.The purpose of this study is to describe coverage of cMDA in study clusters over time and correlates of coverage at individual and cluster levels.Methods From 2018-2020,DeWorm3 delivered six rounds of cMDA with 400 mg albendazole at sites in Benin,India,and Malawi.We report coverage,treatment uptake,and directly observed therapy across all rounds.Factors associated with coverage at the cluster level were identified using binomial generalized estimating equations,while factors associated with non-treatment at the individual level were identified using binomial mixed-effects models.Results Coverage was high across all clusters and rounds,exceeding the WHO target of 75%in all sites and across all rounds(78%to 95%);cluster-level coverage tended to increase over time.Younger,unmarried,and migratory adults were more likely to be untreated at all sites;adult males were more likely to be untreated in Benin and Malawi.Among children,girls were more likely to be untreated,as were non-school-attending and migratory children.Higher adult education was associated with greater odds of non-treatment among adults,but lower odds among children in the household.Belonging to a less wealthy or minority language-speaking household was associated with non-treatment among both adults and children.Conclusions It is possible to deliver community-wide MDA with high coverage.Unique individual and community-level factors influence treatment across settings,and these may be addressed through targeted programming.Trial Registration:Field Studies on the Feasibility of Interrupting the Transmission of Soil-transmitted Helminths(STH),NCT03014167.展开更多
文摘Background: A number of suspected endemic districts with Trachoma have not been mapped in Malawi, and this contributes to delays for scaling up trachoma control activities. Objectives: To determine the prevalence of trachoma and associated risk factors in one of the suspected endemic districts (Salima District) in central Malawi and to generate information to guide policy decisions. Methods: A population-based survey conducted in randomly selected clusters in Salima District (population 418,672), centralMalawi. Children aged 1-9 years and adults aged 15 and above were assessed for clinical signs of trachoma. Results: In total, 884 households were enumerated within 36 clusters. A total of 2765 persons were examined for ocular signs of trachoma. The prevalence of trachomatous inflammation, follicular (TF) among children aged 1-9 years was 17.1% (95% CI 14.9-19.4). The prevalence of trachoma trichiasis (TT) in women aged 15 years and above was 1.3% (CI 0.7-2.3), while the prevalence in men was zero. The presence of a dirty face and lack of sanitation were significantly associated with trachoma follicular (P < 0.001). Conclusion: Prevalence rate of trachoma follicles (TF) in Central Malawi exceeds the WHO guidelines for the intervention with mass antibiotic distribution (TF > 10%), and warrants the trachoma SAFE (Surgery, Antibiotics, Face washing and Environmental hygiene) control strategy to be undertaken in Salima District.
文摘Background:In 2009 Ghana began to design a trachoma pre-validation surveillance plan,based on then-current WHO recommendations.The plan aimed to identify active trachoma resurgence and identify and manage trichiasis cases,through both active and passive surveillance approaches.This paper outlines and reviews the adaptations made by Ghana between 2011 and 2016.The assessment will provide a learning opportunity for a number of countries as they progress towards elimination status.Methods:A mixed methods approach was taken,comprising in-depth interviews and documents review.Between January and April 2016,20 in-depth interviews were conducted with persons involved in the operationalisation of the trachoma surveillance system from across all levels of the health system.A three-tier thematic coding framework was developed using a primarily inductive approach but also allowed for a more iterative approach,which drew on aspects of grounded theory.Results:During the operationalisation of the Ghana surveillance plan there were a number of adaptations(as compared to the WHO recommendations),these included:(i)Inclusion of surveillance of active trachoma in the passive surveillance approach,as compared to trichiasis alone.Issues with case identification,challenges in implementation coverage and a non-specific reporting structure hampered effectiveness;(ii)Random selection and increase in number of sites selected for the active surveillance component.This likely lacked the spatiotemporal power to be able to identify recrudescence in a timely manner;(iii)Targeted trichiasis door-to-door case searches,led by ophthalmic nurses.An effective methodology to identify trichiasis cases but resource intensive;(iv)A buddy system between ophthalmic nurses to support technical skills in an elimination setting where it is difficult to attain diagnostic and surgical skills,due to a lack of cases.The strategy did not take into account the loss of proficiency within experienced personnel.Conclusions:Ghana developed a comprehensive surveillance system that exceeded the WHO recommendations but issues with sensitivity and specificity likely led to an inefficient use of resources.Improved targeted surveillance strategies for identification of recrudescence and trichiasis case searches,need to be evaluated.Strategies must address the contextual changes that arise because of transmission decline,such as loss of surgical skills.
基金Funding is provided by The Bill&Melinda Gates Foundation(OPP1129535)。
文摘Background Soil-transmitted helminths(STH)affect approximately 1.5 billion people globally.The current STH control strategy is annual or twice-annual preventive chemotherapy,typically school-based deworming targeting children and women of reproductive age.Mathematical modeling suggests that it may be possible to interrupt STH transmission through high-coverage community-wide mass drug administration(cMDA).DeWorm3 is a cluster randomized trial testing cMDA for prevalence reduction and transmission interruption.The purpose of this study is to describe coverage of cMDA in study clusters over time and correlates of coverage at individual and cluster levels.Methods From 2018-2020,DeWorm3 delivered six rounds of cMDA with 400 mg albendazole at sites in Benin,India,and Malawi.We report coverage,treatment uptake,and directly observed therapy across all rounds.Factors associated with coverage at the cluster level were identified using binomial generalized estimating equations,while factors associated with non-treatment at the individual level were identified using binomial mixed-effects models.Results Coverage was high across all clusters and rounds,exceeding the WHO target of 75%in all sites and across all rounds(78%to 95%);cluster-level coverage tended to increase over time.Younger,unmarried,and migratory adults were more likely to be untreated at all sites;adult males were more likely to be untreated in Benin and Malawi.Among children,girls were more likely to be untreated,as were non-school-attending and migratory children.Higher adult education was associated with greater odds of non-treatment among adults,but lower odds among children in the household.Belonging to a less wealthy or minority language-speaking household was associated with non-treatment among both adults and children.Conclusions It is possible to deliver community-wide MDA with high coverage.Unique individual and community-level factors influence treatment across settings,and these may be addressed through targeted programming.Trial Registration:Field Studies on the Feasibility of Interrupting the Transmission of Soil-transmitted Helminths(STH),NCT03014167.
