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Prevalence of trachoma at sub-district level in Ethiopia : determining when to stop mass azithromycin distribution

King, Jonathan D. and Teferi, Tesfaye and Cromwell, Elizabeth A. and Zerihun, Mulat and Ngondi, Jeremiah M. and Damte, Mesele and Ayalew, Frew and Tadesse, Zerihun and Gebre, Teshome and Mulualem, Ayelign and Karie, Alemu and Melak, Berhanu and Adugna, Mitku and Gessesse, Demelash and Worku, Abebe and Endashaw, Tekola and Admassu Ayele, Fisseha and Stoller, Nicole E. and King, Mary Rose A. and Mosher, Aryc W. and Gebregzabher, Tesfaye and Haileysus, Geremew and Odermatt, Peter and Utzinger, Jürg and Emerson, Paul M.. (2014) Prevalence of trachoma at sub-district level in Ethiopia : determining when to stop mass azithromycin distribution. PLoS neglected tropical diseases, Vol. 8, H. 3 , e2732.

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Official URL: http://edoc.unibas.ch/dok/A6243516

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Abstract

To 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.; Seventy-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.; Overall, 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%.; The 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 programme and the proximity of hyper-endemic sub-districts.
Faculties and Departments:09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH)
09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH) > Department of Epidemiology and Public Health (EPH) > Eco System Health Sciences > Health Impact Assessment (Utzinger)
09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH) > Department of Epidemiology and Public Health (EPH) > Eco System Health Sciences > Helminths and Health (Odermatt)
UniBasel Contributors:Odermatt, Peter and Utzinger, Jürg
Item Type:Article, refereed
Article Subtype:Research Article
Bibsysno:Link to catalogue
Publisher:Public Library of Science
ISSN:1935-2727
Note:Publication type according to Uni Basel Research Database: Journal article
Language:English
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Last Modified:31 Dec 2015 10:55
Deposited On:23 May 2014 08:33

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