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. 2018 Nov 28;67(12):1840-1846.
doi: 10.1093/cid/ciy377.

Ocular Chlamydia trachomatis Infection Under the Surgery, Antibiotics, Facial Cleanliness, and Environmental Improvement Strategy in Amhara, Ethiopia, 2011-2015

Scott D Nash  1 , Aisha E P Stewart  1 , Mulat Zerihun  2 , Eshetu Sata  2 , Demelash Gessese  2 , Berhanu Melak  2 , Tekola Endeshaw  2 , Melsew Chanyalew  3 , Ambahun Chernet  2 , Belay Bayissasse  2 , Jeanne Moncada  4   5 , Thomas M Lietman  4 , Paul M Emerson  6 , Jonathan D King  7 , Zerihun Tadesse  2 , E Kelly Callahan  1
Affiliations

Ocular Chlamydia trachomatis Infection Under the Surgery, Antibiotics, Facial Cleanliness, and Environmental Improvement Strategy in Amhara, Ethiopia, 2011-2015

Scott D Nash et al. Clin Infect Dis. .

Abstract

Background: World Health Organization (WHO) recommendations for starting and stopping mass antibiotic distributions are based on a clinical sign of trachoma, which is indirectly related to actual infection with the causative agent, Chlamydia trachomatis.

Methods: This study aimed to understand the effect of SAFE (surgery, antibiotics, facial cleanliness, and environmental improvement) interventions on ocular chlamydia in Amhara, Ethiopia, by describing the infection prevalence in a population-based sample of children aged 1-5 years. Trachoma surveys were conducted in all districts of Amhara, from 2011 to 2015 following approximately 5 years of SAFE. Ocular swabs were collected from randomly selected children to estimate the zonal prevalence of chlamydial infection. The Abbott RealTime polymerase chain reaction assay was used to detect C. trachomatis DNA.

Results: A total of 15632 samples were collected across 10 zones of Amhara. The prevalence of chlamydial infection in children aged 1-5 years was 5.7% (95% confidence interval, 4.2%-7.3%; zonal range, 1.0%-18.5%). Chlamydial infection and trachomatous inflammation-intense (TI) among children aged 1-9 years were highly correlated at the zonal level (Spearman correlation [r] = 0.93; P < .001), while chlamydial infection and trachomatous inflammation-follicular were moderately correlated (r = 0.57; P = .084).

Conclusions: After 5 years of SAFE, there is appreciable chlamydial infection in children aged 1-5 years, indicating that transmission has not been interrupted and that interventions should continue. The sign TI was highly correlated with chlamydial infection and can be used as a proxy indicator of infection.

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Figures

Figure 1.
Figure 1.
Geographical distribution of chlamydial infection prevalence among children aged 1–5 years in Amhara, Ethiopia, 2011–2015.
Figure 2.
Figure 2.
Zone-level prevalence of chlamydial infection (Ct), trachomatous inflammation–follicular (TF), and trachomatous inflammation–intense (TI) in Amhara, Ethiopia, 2011–2015.
Figure 3.
Figure 3.
Scatterplot between zone-level prevalence of chlamydial infection (age 1–5 years) and trachomatous inflammation–follicular (TF; A) (age 1–9 years) and trachomatous inflammation–intense (TI; B) (age 1–9 years), Amhara, Ethiopia, 2011–2015.
Figure 4.
Figure 4.
District-level prevalence of chlamydial infection among children aged 1–5 years by trachomatous inflammation–follicular categories in Amhara, Ethiopia, 2011–2015.
See this image and copyright information in PMC

References

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