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BACKGROUND: The Kilimanjaro Diabetic Programme used the Intervention Mapping framework to develop a theory- and evidence-based diabetic retinopathy screening programme. A Working Committee of health care workers and stakeholders ensured community engagement and empowerment of the target audience.OBJECTIVES: To deliver a culturally appropriate, sustainable, community supported health intervention, promoting eye health behaviour change, to prevent avoidable blindness.METHODS: The six steps of the Intervention Mapping protocol incorporated eight components: (1) a needs assessment of people with diabetes and health care workers (2) a clinical trial of diabetic retinopathy screening modes, (3) comic strips as a motivational strategy for diabetic retinopathy screening uptake, (4) health care worker education (5) an electronic database of people with diabetes (6) a self-carry diary (7) implementation of mobile diabetic retinopathy retinal screening (8) process and outcome programme evaluation.RESULTS: The programme eliminated barriers to diabetic retinopathy screening in Kilimanjaro Christian Medical Centre eye and diabetic clinics, placing a digital retinal screening camera in the diabetic clinic and a fast-track screening system in the eye clinic. Two comic strips and a diary provided information about self-management and record of medications, treatment, blood sugar and blood pressure at clinic visits. An annual rural health care worker education programme met requests for knowledge on treatment and care of diabetes, targeting prevention of diabetic retinopathy. Rural digital retinal screening was implemented. Rural diabetes clinics were initiated.CONCLUSIONS: Intervention Mapping provided a systematic, iterative model to formulate and deliver an urban and rural diabetic retinopathy screening programme.TRIAL REGISTRATION NUMBER: ISRCTN31439939. Details available at https://www.isrctn.com/.

INTRODUCTION: Intervention Mapping is the protocol used by the Kilimanjaro Diabetic Programme to plan, develop, implement, and evaluate an evidence-based screening programme for diabetic retinopathy. Two comic strips were developed to deliver the message on the need for diabetic retinopathy screening.OBJECTIVES: The first objective was to develop a culturally appropriate and accessible health message to promote diabetic retinopathy screening for the target audience. The second objective was to deliver a motivational message to promote acceptance of diabetic retinopathy screening irrespective of past eye health behaviour.METHODS: A multi-method research design was used. Social cognitive theory provided the theoretical basis for the intervention, involving community participation to promote positive eye health behaviour.RESULTS: For the Draughts Comic Strip, Flesch-Kincaid readability was 75.7% and comprehension was 87.04%, and for the Soap Opera Comic Strip Flesch-Kincaid readability was 75.6% and comprehension was 86.54%.CONCLUSION: The development of the diabetic retinopathy comic strips was a positive health education strategy implemented during a clinical trial comparing methods of screening for diabetic retinopathy at the Kilimanjaro Christian Medical Centre Hospital. The level of comprehension of the comic strips by stakeholders indicated their understanding of the message. Patients enroled in the clinical trial requested the comic strips. No discarded comic strips were found in the clinic during the clinical trial.TRIAL REGISTRATION: Trial registration number: ISRCTN31439939. Details available at https://www.isrctn.com/ .

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PURPOSE: To assess Eritrea's progress towards elimination of trachoma as a public health problem, we reviewed and compiled current knowledge on the distribution and burden of trachoma in Eritrea, then undertook further population-based surveys where indicated, with support from the Global Trachoma Mapping Project (GTMP). METHODS: For the systematic review, undertaken in March 2014, we searched (1) PubMed, using the terms ((blind* or trachoma or trichiasis) AND Eritrea); (2) the online database of rapid assessments of avoidable blindness; (3) our own grey literature collections; and (4) the Global Atlas of Trachoma database. In June and July 2014, we conducted nine population-based prevalence surveys, for each of which 30 villages were systematically selected with probability proportional to population size; in each village, 30 households were systematically selected. All consenting residents of selected households aged ≥1 year were examined by GTMP-certified graders for signs of trachoma. Data on household-level access to water and sanitation were also collected. RESULTS: One previous rapid assessment of avoidable blindness, three peer-reviewed publications, and two grey literature reports detailing sets of trachoma prevalence surveys conducted in 2006 and 2011, respectively, were located. Post-intervention impact surveys were needed in seven evaluation units (EUs, framed at sub-Zoba-level: population range 40,000-120,000) of Debub and Northern Red Sea, while baseline surveys were needed in two EUs of Anseba. Four of the seven impact survey EUs and both baseline survey EUs returned trachomatous inflammation-follicular prevalences in 1-9-year-olds of ≥5%; six of the seven impact survey EUs and one of the two baseline survey EUs returned trichiasis prevalences in ≥15-year-olds of ≥0.2%. The prevalence of access to water and sanitation varied widely between EUs. CONCLUSION: Interventions are still required in Eritrea to eliminate trachoma as a public health problem. Data from these surveys will guide the Ministry of Health to undertake programme planning using a sound evidence base.

PurposeIn suspected trachoma-endemic areas of Yemen, we sought to determine the prevalence of the sign trachomatous inflammation-follicular (TF) in children aged 1-9years, and the potential individual and household risk factors for TF in that age group. We also sought to determine the prevalence of trichiasis in adults aged ≥15years.MethodsWe conducted a cluster-sampled survey in each of 42 evaluation units (EUs) comprising 166 rural districts of nine Governorates (Adh Dhale'a, Al Hodeihah, Al Jawf, Hadramoot, Hajjah, Ibb, Lahj, Ma'rib, Taiz) using the Global Trachoma Mapping Project systems and methodologies. Fieldwork was undertaken from September 2013 to March 2015. Risk factors for TF in children aged 1-9years were evaluated using multilevel random effects logistic regression.ResultsThe TF prevalence in children aged 1-9years was ≥10% in two EUs (7 districts) and 5-9.9% in six EUs (24 districts). In adults aged ≥15years, trichiasis prevalence was ≥0.2% in five EUs (19 districts). Being older (within the 1-9-year age bracket), being male, living in a household with higher numbers of children, and living in a household that reported the use of open defecation, were each independently associated with higher odds of TF.ConclusionsThese surveys provided baseline data to enable planning for trachoma elimination. The World Health Organization Alliance for the Global Elimination of Trachoma by 2020 stands ready to assist Yemen once security considerations permit further surveys and implementation of control activities.

PurposeFollowing interventions against trachoma in Viet Nam, impact surveys conducted in 2003-2011 suggested that trachoma was no longer a public health problem. In 2014, we undertook surveillance surveys to estimate prevalence of trachomatous inflammation-follicular (TF) and trichiasis.MethodsA population-based prevalence survey was undertaken in 11 evaluation units (EUs) encompassing 24 districts, using Global Trachoma Mapping Project methods. A two-stage cluster sampling design was used in each EU, whereby 20 clusters and 60 children per cluster were sampled. Consenting eligible participants (children aged 1-9years and adults aged ≥50years) were examined for trachoma.ResultsA total of 9391 households were surveyed, and 20,185 participants (98.8% of those enumerated) were examined for trachoma. EU-level TF prevalence in 1-9-year-olds ranged from 0% to 1.6%. In one cluster (in Hà Giang Province), the percentage of children with TF was 10.3%. The overall pattern of cluster-level percentages of children with TF, however, was consistent with an exponential distribution, which would be consistent with trachoma disappearing. Among people aged ≥50years, prevalence of trichiasis by EU ranged from 0% to 0.75%; these estimates are equivalent to 0-0.13% in all ages. The prevalence of trichiasis unknown to the health system among people aged ≥50years, by EU, ranged from 0% to 0.17%, which is equivalent to 0-0.03% in all ages.ConclusionFindings suggest that trachoma is no longer a public health problem in any of the 11 EUs surveyed. However, given the high proportion of children with TF in one cluster in Hà Giang Province, further investigations will be undertaken.

BACKGROUND: Trachoma, a leading cause of blindness, is targeted for global elimination as a public health problem by 2020. In order to contribute to this goal, countries should demonstrate reduction of disease prevalence below specified thresholds, after implementation of the SAFE strategy in areas with defined endemicity. Zimbabwe had not yet generated data on trachoma endemicity and no specific interventions against trachoma have yet been implemented. METHODS: Two trachoma mapping phases were successively implemented in Zimbabwe, with eight districts included in each phase, in September 2014 and October 2015. The methodology of the Global Trachoma Mapping Project was used. RESULTS: Our teams examined 53,211 people for trachoma in 385 sampled clusters. Of 18,196 children aged 1-9 years examined, 1526 (8.4%) had trachomatous inflammation-follicular (TF). Trichiasis was observed in 299 (1.0%) of 29,519 people aged ≥15 years. Of the 16 districts surveyed, 11 (69%) had TF prevalences ≥10% in 1-9-year-olds, indicative of active trachoma being a significant public health problem, requiring implementation of the A, F and E components of the SAFE strategy for at least 3 years. The total estimated trichiasis backlog across the 16 districts was 5506 people. The highest estimated trichiasis burdens were in Binga district (1211 people) and Gokwe North (854 people). CONCLUSION: Implementation of the SAFE strategy is needed in parts of Zimbabwe. In addition, Zimbabwe needs to conduct more baseline trachoma mapping in districts adjacent to those identified here as having a public health problem from the disease.

AIMS: We sought to evaluate trachoma prevalence in all suspected-endemic areas of Benin. METHODS: We conducted population-based surveys covering 26 districts grouped into 11 evaluation units (EUs), using a two-stage, systematic and random, cluster sampling design powered at EU level. In each EU, 23 villages were systematically selected with population proportional to size; 30 households were selected from each village using compact segment sampling. In selected households, we examined all consenting residents aged one year or above for trichiasis, trachomatous inflammation - follicular (TF), and trachomatous inflammation - intense. We calculated the EU-level backlog of trichiasis and delineated the ophthalmic workforce in each EU using local interviews and telephone surveys. RESULTS: At EU-level, the TF prevalence in 1-9-year-olds ranged from 1.9 to 24.0%, with four EUs (incorporating eight districts) demonstrating prevalences ≥5%. The prevalence of trichiasis in adults aged 15+ years ranged from 0.1 to 1.9%. In nine EUs (incorporating 19 districts), the trichiasis prevalence in adults was ≥0.2%. An estimated 11,457 people have trichiasis in an area served by eight ophthalmic clinical officers. CONCLUSION: In northern Benin, over 8000 people need surgery or other interventions for trichiasis to reach the trichiasis elimination threshold prevalence in each EU, and just over one million people need a combination of antibiotics, facial cleanliness and environmental improvement for the purposes of trachoma's elimination as a public health problem. The current distribution of ophthalmic clinical officers does not match surgical needs.

Yaws and trachoma are targeted for eradication and elimination as public health problems. In trachoma-endemic populations mass administration of azithromycin can simultaneously treat yaws. We conducted a population-based prevalence survey in the five northernmost provinces of Vanuatu, where trachoma and yaws are suspected to be co-endemic. Clinical signs of trachoma were evaluated using the WHO simplified grading system, and skin examination with a serological rapid diagnostic test used to identify yaws. We enrolled 1004 households in 59 villages over 16 islands, and examined 3650 individuals of all ages for trachoma. The overall adjusted prevalence of trachomatous inflammation-follicular (TF) in 1–9 year-olds was 12.0% (95% Confidence Interval: 8.1–16.7%), and the overall adjusted prevalence of TT in those aged 15 years and greater was 0.04% (95% CI 0–0.14%). In multivariate analysis, the odds of children having TF was 2.6 (95% CI = 1.5–4.4) times higher in households with unimproved latrines, and independently associated with the number of children in the household (OR 1.3, 95% CI = 1.0–1.6 for each additional child). We examined the skin of 821 children aged 5–14 years. Two children had yaws, giving an estimated prevalence of active yaws in those aged 5–14 years of 0.2% (95% CI = 0.03–0.9%). Mass treatment with azithromycin is recommended in these provinces. Given the apparent low burden of yaws, integration of yaws and trachoma control programmes is likely to be useful and cost-effective to national programmes., Author Summary Yaws and trachoma are infectious diseases targeted by the World Health Organization (WHO) for eradication and elimination as a public health problem, respectively. Both diseases are found in the rural, isolated and underserved communities of the world’s poorest countries. The WHO strategy for trachoma elimination includes Mass Drug Administration (MDA) of the antibiotic azithromycin, with population-based prevalence surveys required to determine where interventions are needed. As yaws can also be treated with azithromycin, in co-endemic areas, azithromycin MDA will likely treat both infections. We conducted an integrated trachoma and yaws prevalence survey in establish the prevalence of both diseases in the 5 northern-most provinces of Vanuatu. The estimated prevalence of trachomatous inflammation—follicular (TF, a sign of C. trachomatis infection) in children aged 1–9 years was 12.0%, and the estimated prevalence of trachomatous trichiasis (TT, advanced, potentially blinding disease) in adults aged 15 years and above was 0.04%. Two children had yaws, giving an estimated prevalence of active yaws in those aged 5–14 years of 0.2%. Mass treatment with azithromycin is recommended in these provinces. Given the apparent low burden of yaws, integration of yaws and trachoma control programmes is likely to be useful and cost-effective to national programmes.

OBJECTIVE: The number of adults with diabetes in sub-Saharan Africa (SSA) is expected to almost double by 2035. This study investigated the prevalence of diabetic retinopathy (DR) and its risk factors at entry into a community-based screening programme. METHODS: All persons with diabetes screened for retinopathy at entry into a screening programme in Kilimanjaro Region, Tanzania between November 2010 and December 2014 were included. Fundus photographs were taken with a Topcon retinal camera following pupil dilation. Data were collected on BP, random blood sugar, duration of diabetes, BMI and visual acuity on entry. RESULTS: A total of 3187 persons were screened for DR. The prevalence of any DR was 27.9% (95%CI 26.4-29.5%) with background diabetic retinopathy (BDR), pre-proliferative diabetic retinopathy (PPDR) and proliferative diabetic retinopathy (PDR) having a prevalence of 19.1% (95% CI 17.7-20.4%), 6.0% (95%CI 5.2-6.8%) and 2.9% (95%CI 2.3-3.5%), respectively. Maculopathy was present in 16.1% (95%CI 14.8-17.4%) of participants. Multivariable logistic regression analysis for the presence of any DR found independent associations with duration of diabetes (P < 0.0001), systolic BP (P < 0.0001), random blood sugar (P < 0.0001) and attending a government hospital diabetic clinic (P = 0.0339). CONCLUSIONS: This study is the first to present data from a DR screening programme in SSA. The results will provide policymakers with data to aid planning of DR screening and treatment services in the African region. The study highlights the importance of managing comorbidities within DR screening programmes.

Teamwork has made a crucial difference to the success of trachoma elimination programmes. However, more trained supervisors are needed.

Study Questionnaire. The interview was conducted in Kiswahili by a native speaker. The structured questionnaire used was pilot tested on 10 patients at Kilimanjaro Christian Medical Centre (KCMC) prior to its use in order to ensure adequate understanding. The answers were recorded in Kiswahili and then translated into English. (DOCX 84Â kb)

The year 2020 is the target date for the elimination of blinding trachoma as a public health problem. There has been great progress, and there is unprecedented funding available – particularly from DFID, the Queen Elizabeth Diamond Jubilee Trust, and USAID. There is also reason for optimism that, over the next five years, further success will be seen in many endemic countries.

Childhood cataracts have become a leading cause of preventable childhood blindness in many areas of the world. Here we summarize regional focus group discussions from the 4th Annual International Congenital Cataract Symposium on the current situation, challenges, and recommendations for the management of congenital cataracts in sub-Saharan Africa, the Middle East and North Africa, South Asia, Central America, South America, and developed nations. Strategies for managing congenital cataracts must be adapted and developed according to regional conditions. A basic framework for acceptable outcomes must focus on developing systems to address the critical components of education, access, quality care, and good follow-up.

Purpose: The purpose of this study was to measure the impact of a community-based intervention on uptake of trichiasis surgery in Southern Egypt. Methods: Four villages where trachoma is endemic were randomly selected in the Samalout district, Egypt. Two villages were selected for intervention (intervention villages) and two matched villages for nonintervention (nonintervention villages). The intervention model provided community information sessions, door-to-door health education, screening, and improvements in the clinical capacity of eye care providers. The intervention was evaluated through two pre - and post-intervention community-based surveys that included the prevalence of trachoma and the utilization of eye care services at local hospitals. All patients with trichiasis answered a questionnaire regarding surgical utilization and barriers. Results: In the baseline survey, the trachomatous trichiasis (TT) surgical coverage was 22.7% (38.9% males, 16.7% females) in all villages. Following the intervention, the TT surgical coverage increased to 68% in villages that received the intervention (81.5% males, 60% females). Nonintervention villages had a TT surgical coverage of 26.1% (37.5% males, 20% females). In the intervention villages, the prevalence of TT significantly decreased from 9.4% (5.7% males, 11.8% females) to 3.8% (1.9% males, 5.1% females) (P = 0.013), in 2008. In nonintervention villages, there was a slight, but insignificant decrease in TT from 10.1% (3.1% males, 14.4% females) to 8.2% (3% males, 11.5% females) (P = 0.580). The major barriers to uptake of TT surgical services were: “Feeling no problem” (17.3%), “fear of surgery” (12.7%) and “cost” (12.7%). Conclusion: A community-based eye health education program with door-to-door screening significantly increased the uptake of TT surgical services. Although improvements to the delivery of surgical service are essential, they did not lead to any significant improvements in the nonintervention villages.

Of the people who are blind in the world today, 64% are female.1 There are three main reasons for this:* in many countries, women live longer than men and are at greater risk of blindness from causes related to age (such as glaucoma and age-related macular degeneration)* some blinding conditions, such as trachoma and cataract, are more likely to affect women than men, whatever their age* women and girls do not access eye care services as often as men and boys.

Is there a problem for women?It often surprises people, but it’s no secret to eye health workers in poor countries, that patients who live with blindness and low vision in these countries often do not make use of existing services. Many programmes, particularly in Africa, struggle to get patients in for surgery. How many eye health workers also know that the problems of access and acceptance are generally worse for women than for men and that women comprise a disproportionate number of the world’s blind?

Purpose: Elimination of trachoma-related blindness requires addressing not only issues of trichiasis surgery availability and accessibility, but also quality. To improve surgeon performance, programmes undertake surgeon audits to identify surgeons needing re-training, reasons for poor outcomes, and actions to optimise surgical outcomes. This study aims to determine the frequency and associated factors of audits conducted in selected countries and factors associated with failed audits. Methods: A multicentric study was conducted as a secondary data analysis of surgeon audit results for eight African countries. Stata® was used to generate results for chi-square tests for association, odds ratio and 95% confidence intervals between independent samples for categorical variables and one-way ANOVA tests for continuous variables. Results: The study included 561 trichiasis surgeons and 193 (34.4%) had an audit. Dedicated eye care workers were more likely to have an audit (p

The secondary analysis undertaken for this MPH dissertation examines the global prevalence of trichiasis in relation to gender in trachoma endemic countries. Part A is the research protocol which outlines the background and the process of this research. This study is a population-based analytical study using data from the Global Trachoma Mapping Project (GTMP). GTMP was a standardized population-based trachoma prevalence survey undertaken to provide trachoma prevalence estimates. GTMP data was collected using the World Health Organisation–recommended population based prevalence survey methodology. Trachoma suspect district were identified for inclusion and multistage random sampling was used to sample households for examination of residents for clinical trachoma. Part B presents the background and highlights the importance of this research by exploring the existing theoretical and empirical literature relevant to the topic. It describes how trachoma is transmitted, its clinical manifestations, and the way it can lead to blindness. Results from previous studies on gender and trichiasis are presented. Part C presents the research project in a format suitable for journal submission. The background of this research project is summarized and the meta-analysis is conducted at the global level, at the country level, the regional level, the state level and at the EU level but all in accordance to prevalence of trichiasis in the EUs. The implications of the findings are discussed and limitations in interpretation presented.

As at 2014, 19 million children aged < 16 years were visually impaired, 1.4 million of these children were blind and needed visual rehabilitation interventions. Surveys, mostly utilizing key informants (KI), have suggested that the prevalence of blindness in children in Sub Saharan Africa ranges between 2 -8 per 10,000 children. Childhood eye disease is rare and conditions are difficult to detect; thus, surveys to estimate the prevalence of blindness requires rigorous, costly and difficult methods to obtain reasonable estimates among children. Key informant programs, which engage the community in case finding, have been shown to be a reasonable alternative to large scale surveys and were used in Madagascar in 2014 by four regional eye care programmes. I propose to analyse the data generated from the programmes to quantify the prevalence of eye conditions among children and how the KIs performed. Method: The analysis will use data collected in a cross sectional approach. Statistical analysis will be conducted using Stata (15.0) statistical software. Data from all of the KI registers will be pooled and overall magnitude estimates calculated. KI productivity and sub-group analyses will include assessment of demographic characteristics of the children and the KI by age and sex. Ethical approval will be provided by the UCT Health Research and Ethics Committee and the Madagascar Ministry of Health. Discussion: The results from this study will help child eye health programmes to determine how best to use KI to better serve children with vision loss, and guide in the provision of eye services for children care.

Background High incidence of post-operative trichiasis and other poor outcomes after surgery in most trachoma-endemic settings poses a major challenge to global elimination of trachoma. This systematic review aimed to assess the incidence of post-operative trichiasis and other poor outcomes of trichiasis surgery in Africa, based on findings of observational and interventional studies. Search methods We searched PubMed, Academic Search Premier, Africa-Wide Information, CINAHL and Health Source Nursing through EBSCOhost, Web of Science [all databases], and Cochrane Central Register of Controlled Trials for relevant studies on the subject. We also searched the reference lists of included studies to identify further potentially relevant studies. We included all observational and interventional studies that measured post-operative trichiasis as one of the primary outcomes. Only studies conducted in Africa were included in this review. Data collection and analysis Two reviewers independently screened the titles and abstracts, selected and assessed the articles for inclusion in this review. Any disagreements were resolved through discussion or by consulting a third reviewer. Where necessary, the corresponding authors of included studies were contacted to provide any missing data. Our primary outcome was post-operative trichiasis, which was defined as any eyelash touching the globe at different time points after surgery. Main results Thirty-five studies, including 12,943 participants, met the inclusion criteria. A number of the studies included in this review utilized the same data to measure the incidence of post-operative trichiasis and other poor outcomes over different follow-up periods. Overall, a review of the included studies revealed a pattern of high incidence of post-operative trichiasis and other poor outcomes ranging from 2.3 at 6 weeks to 65% at 7 years. This incidence varied by type of study design, surgical procedure and technique used as well as the follow up period among other factors.

Background: Diabetes Mellitus is an emerging public health problem in Africa. Evidence suggests that globalization, rapid urbanization and a nutritional transition have led to the rise in the prevalence of diabetes mellitus in Africa. Diabetic retinopathy is a common complication of diabetes mellitus that causes visual impairment and subsequent blindness. Early detection and prompt treatment can prevent blindness in up to 90% of patients. The common risk factors for diabetic retinopathy include hypertension, hyperglycemia and long duration of diabetes. Other risk factors include obesity, hyperlipidemia, smoking, puberty and pregnancy. There is limited data on diabetic retinopathy and its associated risk factors in Zambia. An understanding of these factors would help in the effective management of diabetic retinopathy. Methods: A secondary data analysis of data obtained from a hospital-based cross-sectional study of diabetic patients attending diabetic clinics in the Copperbelt Province in Zambia was carried out. All diabetic patients that attended the retinopathy-screening program between April 2012 and September 2012 were eligible for the primary study. The secondary data analysis was restricted to patients 18 years and older. Data analysis was carried out by R version 3.3.1. The characteristics of the study population were summarized using descriptive statistics. Univariate logistic regression analysis was used to select potential candidates for the multivariate regression model at p-value cutoff point ≤ 0.25 and variables of known clinical relevance were also included in the multivariable analysis. The final model fitness was checked using Hosmer and Lemeshow chi-square test. Finally, statistical significance was tested at P-value

Background: Trachoma is the leading cause of infectious eye disease that leads to blindness. Continuous re-infection by the bacteria, Chlamydia trachomatis, leads to scarring of the cornea and subsequently to blindness. It is commonly found in the poorest and remotest part of Africa, Asia, Latin America and Mid-east, where hygienic conditions are also poorer. The Alliance for the Global Elimination of Blinding Trachoma by the year 2020 (GET 2020) was launched by World Health Organization (WHO) with the main aim of eliminating trachoma as a public health problem globally by year 2020. The Alliance funded Sightsavers, as part of the strategy to meet this target, to set up the Global Trachoma Mapping Project (GTMP) which was to map all endemic places for intervention through a population-based prevalence survey. There are five main signs of the disease and the number of people affected by each sign explains the magnitude and the intervention needed in that population. WHO recommends the active trachoma survey in children age 1-9 years and the blinding signs in adults' age 15 years and above. More researches, that establish quicker means of intervention for the endemic trachoma areas, are needed using the GTMP data in order to meet the year 2020 target. Methods: Baseline data from the Global Trachoma Mapping Project (GTMP) was used as a secondary dataset for this research. All eligible regions in Ethiopia were included. The GTMP teams conducted surveys in seven regions. All age groups were included, but for the purpose of planning, the study assessed TF in children age 1-9 years and TT in adults age 15 years and above. The prevalence of TF in children and TT in adults are indicators for programme decision making for intervention and establishing the relationship between them would aid in the intervention. The relationship if established could help in planning the extent of intervention needed in a given population. Data on sanitation and hygiene as well as altitude, which were collected as part of GTMP, were assessed to determine if they contributed to relationship between TF and TT. Results: The study included a total of 282,558 individuals living in 174 evaluation units from seven regions of Ethiopia, among whom 256,587 gave consent to be examined. This study found a significant relationship between the prevalence of TF in children and the prevalence of TT in adults when analysis is done at the evaluation unit level (correlation rho, 0.59; p-value

Background: Cataract remains the leading cause of blindness in Africa. We sought to review the available literature relating to barriers to cataract surgery in Africa. Methods: A review of the literature was undertaken using PubMed and Google Scholar using the search terms "barriers, cataract, Africa, cataract surgery, cataract surgical coverage (CSC), and Rapid Assessment of Avoidable Blindness (RAAB)". The review covered the period 1999-2014. Results: In RAABs, barriers related to awareness and access were more commonly reported than acceptance, while non -RAAB studies reported cost as the most commonly reported barrier. The few qualitative studies tended to report community and family dynamics with regard to barriers to cataract surgery. CSC was reported as lower in females in 88.2% of the studies. Conclusion: Studies of barriers to cataract surgery give variable responses. This may be due to the study context but also may be due to the type of data collection. It is likely that qualitative data will give a deeper understanding of the complex social, family, community, financial and gender issues relating to barriers to uptake of cataract surgery in Africa.