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• W2765645033 abstract "Background: Trachoma, a blinding bacterial disease of the ocular surface, is the leadingcause of infectious blindness, responsible for the visual impairment of 2.2 million peopleworldwide and an estimated economic loss of US$ 5.3 billion annually. Blinding trachoma,considered a neglected tropical disease, is targeted for global elimination as a public healthproblem by the year 2020. To achieve elimination, the World Health Organization (WHO)recommends implementing an integrated intervention package of surgery, antibiotics, facialcleanliness, and environmental improvement, known as the SAFE strategy. Surgery aims tocorrect trichiasis, the blinding anatomical condition of inward turning lashes touching the eye.Antibiotics are distributed annually to endemic communities to treat relatively asymptomaticocular Chlamydia trachomatis infections to reduce the infectious reservoir. The promotion offacial cleanliness and environmental improvements, use of water and latrines for hygieneand sanitation, both target interrupting transmission of the infection. Of the 325 millionpersons estimated living in trachoma endemic communities, over 70% reside in sub-SaharanAfrica. Within the region, Ethiopia, Nigeria, and South Sudan are estimated to have thehighest burden of disease. The SAFE strategy in Ethiopia has been implemented since 2007targeting all 17 million residents of the Amhara National Regional State.Goals and specific objectives: The goal of this PhD thesis was to investigate novelapproaches of measuring the impact of SAFE interventions on trachoma and otherneglected tropical diseases within the context of a national elimination programme asimplemented in the Amhara National Regional State of Ethiopia. The specific operationalresearch objectives were to determine whether areas receiving 3-5 years of interventionshad achieved elimination by applying new evaluation guidelines; whether new electronicdata collection technology could facilitate impact evaluation; whether SAFE interventionshad any impact on trachomatous scarring (TS) among children; whether school-basedsurveys might serve as an alternative method to assess trachoma; and whether SAFEinterventions have had any impact on intestinal parasitic infections.Methods: Data collection for the thesis project occurred in three phases. The first phaseinvolved the implementation of a population-based, cross-sectional study utilising a clusterrandom sampling design to survey 360 communities in South Wollo zone to estimateprevalence of trachoma after three years of SAFE interventions. Data was collected usingstandard paper-based questionnaires. The second phase involved the development andfield-testing of a new electronic data collection system in a pilot study utilising a mixed,quantitative and qualitative, study design. The last phase involved the implementation ofanother population-based cross-sectional study in South Gondar zone after receiving fiveyears of SAFE interventions. The same sampling methodology was used to survey another360 communities, yet integrating both assessment of trachoma and intestinal parasiticinfections. Additionally, data was collected strictly by the newly developed electronic system.Clinical signs of trachoma were individually assessed using the WHO simplified trachomagrading system. Intestinal parasitic infections among children aged 2-15 years weredetermined by concentrating preserved stool specimens with ether for microscopicexamination.Results: From 714 communities in the two zones, 72,452 persons were examined fortrachoma. The prevalence of trachomatous inflammation follicular (TF) among children aged1-9 years was 26.4% in South Wollo and 25.9% in South Gondar zone. Trachomatousinflammation intense (TI) was less prevalent than TF; 4.3% and 7.0% in South Wollo andSouth Gondar respectively. TT prevalence in the two zones suggest that over 59,000persons are estimated to have trichiasis and in need of surgery. In South Gondar theprevalence of TS among children under the age of 11 years has declined from 24.9% in2000 to 2.2% in 2011. While declines in intense inflammation and scarring were observedamong children since intervention, the WHO targets for elimination have not been achieved.The android-based tablet computer and the standard paper questionnaire werecomparable in regards to time required to collect data during the pilot study, proportion ofmistakes made while recording data and costs when considering data entry of paperquestionnaires. Data recorders preferred to collect data electronically even though initiallythey felt the tablet interrupted their connection with the interview respondents. Electronicdata collection resulted in completion of the large-scale surveys from preparation topresentation of results in 35% less time (one month earlier) than the standard paper-basedsurveys.An analysis of 75,864 children examined in community-based surveys in Ethiopia(from field work described in this thesis), Mali, Niger, and Nigeria found that differencesbetween children who attend and do not attend school varies across survey settings inregards to age, gender, having a clean face, and participation in antibiotic distribution fortrachoma control. Meta-analysis of the data found that TF was less likely (odds ratio=0.71)among school-attendees than non-attendees when controlling for age, sex, and clustering atthe household and community levels. Children attending school did not represent the targetage group recommended for assessment of trachoma prevalence.Stool specimens from 2,338 children aged 2-15 years from 99 communities in SouthGondar were assessed for intestinal parasites. The prevalence of any helminth infection was24.2%, which represented a 50% reduction from a previously published study prior to theSAFE interventions. Over 70% of children had at least one type of intestinal protozoaninfection. Significant increases were observed in household latrine ownership, access towater, use of an improved water source for drinking, and face washing behaviour since thestart of the interventions.Conclusions: Trachoma remains a public health problem in South Wollo and South Gondarzones of the Amhara National Regional State of Ethiopia and ongoing interventions arewarranted to control transmission to prevent incident blinding disease and provide surgeryfor prevalent and incident cases of trichiasis. The application of new WHO guidelines toevaluate trachoma at the sub-district level was feasible, but required significant resources.Electronic data capture facilitates the implementation of such large-scale impact evaluationsurveys for neglected tropical diseases allowing the results to be generated immediately withas few mistakes as were made with paper-based data collection. Measuring prevalence ofTS among children over time offers an additional way to monitor impact of the SAFEstrategy. Children under the age of 11 years have substantially benefited from having lived inan environment where the SAFE strategy has been implemented for five years. The use ofschool-based sampling approaches for assessing trachoma prevalence risksunderestimating true prevalence in the community. The prevalence of intestinal helminthsamong school-aged children has declined alongside significant increases in household-levelindicators of water, sanitation, and hygiene since the implementation of the SAFE strategy inSouth Gondar. Yet, there is ongoing transmission of intestinal parasitic infections warrantingimproved control interventions. Integrating both the assessment of trachoma and intestinalparasitic infections in community-based surveys was a feasible approach to evaluate abroader impact of the SAFE strategy in a programmatic setting. Overall, the operationalresearch presented in this thesis successfully generated evidence for health systemdecisions, contributed new information to the respective scientific fields, and identified areaswarranting additional research." @default.
• W2765645033 created "2017-11-10" @default.
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• W2765645033 date "2014-01-01" @default.
• W2765645033 modified "2023-09-24" @default.
• W2765645033 title "Novel approaches to evaluate the impact of the SAFE strategy on trachoma and other neglected tropical diseases in Amhara National Regional State, Ethiopia" @default.
• W2765645033 doi "https://doi.org/10.5451/unibas-006285774" @default.
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