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. 2014 Mar 13;8(3):e2732.
doi: 10.1371/journal.pntd.0002732. eCollection 2014 Mar.

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

Jonathan D King  1 , Tesfaye Teferi  2 , Elizabeth A Cromwell  3 , Mulat Zerihun  2 , Jeremiah M Ngondi  4 , Mesele Damte  2 , Frew Ayalew  2 , Zerihun Tadesse  2 , Teshome Gebre  2 , Ayelign Mulualem  5 , Alemu Karie  5 , Berhanu Melak  2 , Mitku Adugna  2 , Demelash Gessesse  2 , Abebe Worku  5 , Tekola Endashaw  2 , Fisseha Admassu Ayele  5 , Nicole E Stoller  6 , Mary Rose A King  3 , Aryc W Mosher  3 , Tesfaye Gebregzabher  2 , Geremew Haileysus  2 , Peter Odermatt  7 , Jürg Utzinger  7 , Paul M Emerson  3
Affiliations

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

Jonathan D King et al. PLoS Negl Trop Dis. .

Abstract

Background: 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.

Methodology: 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.

Principal findings: 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%.

Conclusions/significance: 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 program and the proximity of hyper-endemic sub-districts.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Administrative levels and respective population structure of Amhara National Regional State, Ethiopia.
Figure 2
Figure 2. Surveyed communities in South Gondar and South Wollo zones of Amhara National Regional State, Ethiopia.
Figure 3
Figure 3. Distribution of trachomatous inflammation folliclar (TF) among children aged 1–9 years in Amhara National Regional State, Ethiopia.
Data are stratified by woreda and evaluation unit.
Figure 4
Figure 4. Prevalence of active trachoma and clinical signs among children aged 1–9 years in Amhara National Regional State, Ethiopia.
Data are shown for the years 2003, 2006, and 2010–2011.
See this image and copyright information in PMC

References

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    1. WHO (1997) Future approaches to trachoma control. Geneva: World Health Organization.
    1. Resnikoff S, Huguet P, Mariotti SP (2007) Certification of the elimination of blinding trachoma by the World Health Organization. Rev Int Trach Pathol Ocul Trop Subtrop Sante Publique 84: 59–68.

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