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ABSTRACT: To evaluate the change in household latrine coverage and investigated predictors of latrine uptake after 3 years of implementation of trachoma control interventions in Dera, Ebinat, Estie, Enebsie Sarmedir and Huleteju Enese districts of Amhara, Ethiopia.
Before and after study, baseline surveys were conducted prior to programme implementation and an evaluation after 3 years of interventions. Multi-stage cluster random sampling was used in both surveys.
A total of 1096 and 1117 households were sampled and assessed for the presence of household latrines at baseline and evaluation, respectively. The proportion of households with a pit latrine increased by 32.3% overall (95% confidence interval [CI]: 27.9-38.0), ranging from 8.0% (95% CI: 5.1-10.8) in Ebinat to 58.9% (95% CI: 51.9-66.8) in Enebsie Sarmedir. Logistic regression analysis of associations between household latrine ownership and potential factors showed that increasing household size (OR(per additional person) = 1.2[95% CI: 1.1-1.3]), higher socio-economic status (tin roof) (OR = 1.8[95% CI: 1.2-2.9]) and participation in health education (OR = 1.6[95% CI: 1.1-2.5]) were independent predictors of latrine ownership.
Our study documented heterogeneous increase in household latrine coverage after 3 years of latrine promotion; two of five districts had achieved Millennium Development Goal 7.9 and halved the proportion of households without latrine access. We attribute the striking increase in household latrines to increased political commitment of the local government and intensive community mobilisation under the trachoma control programme in Amhara region.
Tropical Medicine & International Health 03/2010; 15(5):592-9. · 2.80 Impact Factor
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ABSTRACT: The WHO recommends the SAFE (surgery, antibiotics, facial cleanliness and environmental improvement) strategy for trachoma control. We aimed to investigate the association between active trachoma and community intervention with antibiotics, facial cleanliness, environmental improvement (A,F,E) components of SAFE in five trachoma hyperendemic districts of Amhara region, Ethiopia.
Cluster random surveys were undertaken to evaluate SAFE following 3 years of interventions. Children aged 1-9 years were examined for trachoma signs using the WHO simplified grading system and structured questionnaires used to assess uptake of A, F and E. Active trachoma signs (trachomatous inflammation-follicular (TF) and trachomatous inflammation-intense (TI)) were used to derive an ordinal severity score where TI was considered more severe than TF. Associations between active trachoma and potential factors were investigated using ordinal logistic multilevel regression models.
A total of 1813 children aged 1-9 years were included in the analysis. Factors independently associated with reduced odds of active trachoma signs were: number of times treated with azithromycin (p-trend=0.026); months since last mass azithromycin distribution (p-trend<0.001); clean face (OR=0.6; 95% CI 0.5 to 0.8); and household pit latrine (OR=0.8; 95% CI 0.7 to 0.9).
These findings are important, since they make the case for continued implementing the A,F,E interventions simultaneously, and suggest appropriate timing of SAFE evaluations within 6-12 months after the last mass azithromycin distribution.
The British journal of ophthalmology 11/2009; 94(3):278-81. · 2.92 Impact Factor
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Jeremiah Ngondi,
Teshome Gebre,
Estifanos B Shargie, Liknaw Adamu,
Yeshewamebrat Ejigsemahu,
Tesfaye Teferi,
Mulat Zerihun,
Berhan Ayele,
Vicky Cevallos,
Jonathan King,
Paul M Emerson
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ABSTRACT: Trachoma surveys were conducted at baseline in five districts of Amhara National Regional State, Ethiopia (7478 participants in 1096 households) and at 3-year evaluation (5762 participants in 1117 households). Uptake of SAFE was assessed with programme monitoring data and interviews, and children (1-6 years) were swabbed for detection of ocular Chlamydia. At evaluation, 23,933 people had received trichiasis surgery; 93% of participants reported taking azithromycin at least once; 67% of household respondents (range 46-93) reported participation in trachoma health education; and household latrine coverage increased from 2% to 34%. In children aged 1-9 years percentage decline, by district, for outcomes was: 32% (95% CI 19-48) to 88% (95% CI 83-91) for trachomatous inflammation-follicular (TF); 87% (95% CI 83-91) to 99% (95% CI 97-100) for trachomatous inflammation-intense (TI); and 31% increase (95% CI -42 to -19) to 89% decrease (95% CI 85-93) for unclean face; and in adults percentage decline in trichiasis was 45% (95% CI -13 to 78) to 92% (95% CI 78-96). Overall prevalence of swabs positive for ocular Chlamydia was 3.1%. Although there were substantial reductions in outcomes in children and adults, the presence of ocular Chlamydia and TF in children suggests ongoing transmission. Continued implementation of SAFE is warranted.
Transactions of the Royal Society of Tropical Medicine and Hygiene 02/2009; 103(10):1001-10. · 2.16 Impact Factor
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ABSTRACT: Limited surveys and anecdotal data indicate that trachoma is endemic in the states of Eastern Equatoria and Upper Nile in southern Sudan. However, its magnitude and geographical distribution are largely unknown. We conducted surveys to ascertain the prevalence and geographical distribution of trachoma, and to identify targets for control interventions.
Population-based cross-sectional surveys were conducted in nine sites in southern Sudan between September 2001 and June 2004. Two-stage random cluster sampling with probability proportional to size was used to select the sample. Trachoma grading was done using the WHO simplified grading system.
A total of 17 016 persons were examined, a response rate of 86.1% of the enumerated population. Prevalence of signs of active trachoma in children aged 1-9 years was: TF=53.7% (95% confidence interval (CI)=52.1-55.3); TI=42.7% (95% CI=41.2-44.2); TF and/or TI=64.1% (95% CI=62.5-65.5). Prevalence of trichiasis (TT) in children aged less than 15 years was 1.2% (95% CI=0.9-1.4), while TT prevalence in persons aged 15 years and above was 9.2% (95% CI=8.6-9.9). Women were more likely to have trichiasis compared to men (odds ratio (OR)=1.57; 95% CI=1.34-1.84). Tentative extrapolation to the states of Eastern Equatoria and Upper Nile estimates that there is a backlog of 178,250 (lower and upper bounds=156,027-205,995) persons requiring surgery and the entire population, estimated to be over 3.9 million, is in need of the SAFE strategy to control blinding trachoma.
Trachoma is a public health problem in all nine of the study sites surveyed. The unusually high prevalence of active trachoma and TT in children points to the severity of the problem. There is urgent need to implement trachoma control interventions in trachoma endemic regions of southern Sudan.
Bulletin of the World Health Organisation 01/2006; 83(12):904-12. · 4.64 Impact Factor
