Twelve-Year Longitudinal Trends in Trachoma Prevalence among Children Aged 1-9 Years in Amhara, Ethiopia, 2007-2019

Abstract

Trachoma control in the Amhara region of Ethiopia, where all districts were once endemic, began in 2001 and attained full scale-up of the Surgery, Antibiotics, Facial cleanliness, and Environmental improvement (SAFE) strategy by 2010. Since scaling up, the program has distributed approximately 14 million doses of antibiotic per year, implemented village- and school-based health education, and promoted latrine construction. This report aims to provide an update on the prevalence of trachoma among children aged 1-9 years as of the most recent impact or surveillance survey in all 160 districts of Amhara. As of 2019, 45 (28%) districts had a trachomatous inflammation-follicular (TF) prevalence below the 5% elimination threshold. There was a statistically significant relationship between TF prevalence observed at the first impact survey (2010-2015) and eventual achievement of TF < 5% (2015-2019). Of the 26 districts with a first impact survey < 10% TF, 20 (76.9%) had < 5% TF at the most recent survey. Of the 75 districts with a first survey between 10% and 29.9% TF, 21 (28.0%) had < 5% TF at the most recent survey. Finally, among 59 districts ≥ 30% TF at the first survey, four (6.8%) had < 5% TF by 2019. As of 2019, 30 (18.8%) districts remained with TF ≥ 30%. Amhara has seen considerable reductions of trachoma since the start of the program. A strong commitment to the SAFE strategy coupled with data-driven enhancements to that strategy is necessary to facilitate timely elimination of trachoma as a public health problem regionally in Amhara and nationwide in Ethiopia.

Figure 1.

Prevalence distribution of water, sanitation, and hygiene indicators by zone, Amhara, Ethiopia, 2015–2019. Figures show the median, first and third quartiles, range, and outliers. *Clean face and sanitation were directly observed. Improved sanitation defined as at least a pit latrine with at least a slab of concrete; improved water defined as one of the following: protected spring, hand pump/tube well/borehole, public piped water/tap/standpipe, private piped into yard/dwelling, or rainwater collection. This figure appears in color at www.ajtmh.org.

Figure 2.

Trachomatous inflammation-follicular (TF) prevalence over time among districts with a first impact survey at prevalence less than 10% among children aged 1–9 years, Amhara, Ethiopia, 2007–2019 (n = 26). Triangles represent zonal-level baseline estimates. This figure appears in color at www.ajtmh.org.

Figure 3.

Trachomatous inflammation-follicular (TF) prevalence over time among districts with a first impact survey at prevalence between 10% and 29.9% among children aged 1–9 years, Amhara, Ethiopia, 2007–2019 (n = 75). Triangles represent zonal-level baseline estimates. This figure appears in color at www.ajtmh.org.

Figure 4.

Trachomatous inflammation-follicular (TF) prevalence over time among districts with a first impact survey at prevalence greater than or equal to 30% among children aged 1–9 years, Amhara, Ethiopia, 2007–2019 (n = 59). Triangles represent zonal-level baseline estimates. This figure appears in color at www.ajtmh.org.

Figure 5.

District-level trachomatous inflammation-intense (TI) prevalence over time among children aged 1–9 years by zone, Amhara, Ethiopia, 2010–2019 (n = 160). This figure appears in color at www.ajtmh.org.

Figure 6.

Longitudinal trends in the prevalence of Trachomatous inflammation-follicular (TF) among children aged 1–9 years for those 37 districts which reached surveillance survey, Amhara, Ethiopia, 2011–2019. *Districts are grouped by their respective zone to aid in visualization. This figure appears in color at www.ajtmh.org.

Figure 7.

Age-specific prevalence of (A) trachomatous inflammation-follicular (TF) and (B) trachomatous inflammation-intense (TI) among children aged 1–9 years for surveys conducted as part of the first impact surveys (2010–2015) and for those conducted in the most recent round of surveys (2015–2019), Amhara, Ethiopia. This figure appears in color at www.ajtmh.org.