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Herein, we investigated methylammonium lead bromide (MAPbBr3) perovskite materials obtained using a cost-effective spin-coating technique. An important step toward the excellent production of perovskite thin films is antisolvent treatment. The influence of thermal annealing and two different antisolvents (toluene and chlorobenzene) treatments have been studied on the phase formation and microstructure of the perovskite films using X-ray diffraction analysis, SEM, UV–visible, and photoluminescence. The findings reveal that using the appropriate antisolvent resulted in the formation of homogenous perovskite films with almost no holes and large grains and also improved the morphology of the thin film with antisolvents. Subsequently, we analyzed the results to study the characteristics of different perovskite solar cells (PSCs) produced by different antisolvent using a solar cell capacity simulator (SCAPS). The thickness, defect and acceptor densities were optimized. It is found that an optimal thickness of 500 nm has a detrimental effect on the PSC' s performance. Indeed, better results were obtained: fill factor FF = 93.02%, Jsc = 8.87 mA/cm2, PCE = 17.42%, and Voc = 2.10 V of MAPbBr3-based solar cells where MAPbBr3 treated by Chlorobenzene Fresh. The use of chlorobenzene antisolvent showed an enhancement of the perovskite solar cell' s efficiency. The findings may be of interest to serve in the development of reproducible production procedures of PSCs. [ABSTRACT FROM AUTHOR]

Background: Control programs for trachoma use mass antibiotic distributions to treat ocular Chlamydia trachomatis in an effort to eliminate this disease worldwide. To determine whether children infected with ocular Chlamydia are more likely to present late

Antimicrobials are used primarily to treat infectious disease, but they have other effects. Here, we assess anthropometry measurements in children 6-60 months in 24 communities randomized to one or two mass azithromycin distributions over a 1-year period i

Amaç: Bu çalışmada idyopatik karpal tünel sendromu (KTS) tanısı almış hastalarda klinik, fiziksel, elektrofizyolojik, fonksiyonel bulgular ve vücut kitle indeksi (VKİ) arasındaki ilişkiyi araştırmak amaçlanmıştır. Method: Çalışmaya toplam 105 (48 bilateral, 9 unilateral) idiopatik KTS’li el katıldı. Hastaların demografik ve klinik bulguları ve tinel, phalen, ters phalen, karpal kompresyon bulguları değerlendirilerek kaydedildi. VKİ ≥ 30 olan hastalar obez olarak değerlendirildi. Hastaların fonksiyonlarını değerlendirmek amacıyla Boston Semptom Şiddet ve fonksiyonel kapasite skalası uygulandı. Hastalar klinik ve elektrofiyolojik incelemelerine göre evrelendirildiler. Bulgular: Hastaların yaş ortalaması 44.09 ± 10.97 idi. Elektofizyolojik evreleme ile yaş, cinsiyet, fonksiyonel kapasite ve semptom şiddet derecesi arasında istatistiksel olarak anlamlılık saptanmazken, provakatif testlerden tinel testi pozitifliği ile ağır KTS arasında ve klinik evreleri ile KTS derecesi arasında anlamlı bir ilişki saptandı. Semptom şiddeti ve fonksiyonel kapasitesi, obez hasta grubunda, obez olmayan gruba göre anlamlı olarak daha yüksek bulundu. Obez ve obez olmayan grubun elektrofizyolojik özellikleri karşılaştırıldığında obez grubun median sinir duysal amplitüd değeri anlamlı olarak obez olmayan gruba göre düşük saptandı Sonuç: Obez KTS’li hastaların fonksiyon kaybı ve şiddet semptomlarının, obez olmayanlara göre daha fazla olması, bu hastalarının tedavisinde kilo kontrolünün önemini göstermektedir. Klinik bulgu ile elektrofizyolojik bulguların birbirini desteklemediği durumlarda, dikkatli bir muayene ile hastalık şiddeti hakkında bilgi edinilebileceği, ayrıca tedavinin etkinliğinin değerlendirilmesi ve hastaların takibinde yararlı olacağını düşünüyoruz. Yine hastalık takibinde özellikle fonksiyon kaybının ve şiddet semptomların değerlendirilmesinde uyarıcı testlerinin önemli olduğunu ve muayenemizde rutin olarak yer alması gerektiğini düşünmekteyiz.

Bu araştırma sekizinci sınıf öğrencilerinin üstbilişsel okuma stratejilerini kullanma düzeyleri ile okuma anlama başarıları arasında nasıl bir ilişki vardır sorusunu yanıtlamak amacıyla ilişkisel tarama modelinde nicel araştırma yöntemine başvurularak yapılmıştır. Araştırma; 2021–2022 eğitim-öğretim yılında Adana’nın Çukurova ilçesinde Millî Eğitim Bakanlığına bağlı resmi ortaokullarda okuyan sekizinci sınıf öğrencileriyle gerçekleştirilmiştir. Araştırmanın dayandığı evrenin değeri 6454’tür; örneklemin değeri ise 700’dür. Araştırmada okuma anlama başarımı testi ve üstbilişsel okuma stratejileri ölçeği kullanılmıştır. Verilerin dağılım özelliği dikkate alınarak güvenilirlik analizleri, betimleyici analizler, Pearson korelasyon ve regresyon analizi, Kruskal Wallis-H ve Mann-Whitney-U testi yapılmıştır. Araştırmanın sonucunda, ölçek genelinde üstbilişsel okuma stratejileri, genel okuma ve destekleyici okuma stratejileri orta düzeyde; sorun çözme stratejileri ise yüksek düzeyde kullanılmıştır. Katılımcıların okuma anlama başarımı orta düzeyde bulunmuştur. Genel okuma, sorun çözme ve destekleyici okuma stratejileri ile okuma anlama başarımı arasında pozitif yönde, orta düzeyde, anlamlı bir ilişki bulunmuştur. Bu yüzden Türkçe derslerinde stratejiye dayalı okuma sürecine yer verilmesinin okuduğunu anlama başarısını arttıracağı düşünülmektedir.

This study aims to clarify the impact of intellectual capital in its three dimensions: human, structural and relational on the quality of higher éducatise. These five most important dimensions, reliability, security, concreteness, responsiveness and empathy. to achieve this study based on a descriptive and analytical approach. The questionnaire is also used as the main means of data collection, which is distributed to a sample of 40 faculty members (permanent and temporary) at the Faculty of Economics, Business and Management at Tahri Mohammed University. 39 of them are collected and unloaded. Data via SPSS. The study achieved a set of results. The most important is that intellectual capital has a strong impact on the quality of higher education at the Faculty of Economics, Business and Management at Tahri Mohammed Bechar University, and that intellectual capital contributes to the development of the quality of education. But this result is still dependent on the college's willingness to maintain the type of human investment and to develop it through effective management in a way that helps design and implement an integrated strategic plan.

Research aims to test the influence of macroeconomic and microeconomic factors in the problem financing of Sharia Bank in Indonesia. The indicators of macroeconomic and microeconomic factors are inflation, BI Rate, CAR and FDR. The indicators of problematic financing of Sharia Bank in Indonesia is NPF. The research method uses a quantitative approach with multiple linear regression analysis techniques. Data used secondary data in the form of a monthly data From The Financial Report of Sharia Commercial Bank and Sharia Business Unit published by Sharia Banking Directorate, Bank Indonesia and the Bank Licensing and Banking Information Department, Indonesia Financial Services Authority through Sharia Banking Statistics Bank Indonesia/Indonesia Financial Services Authority from January 2006 to Juli 2016. The following research results: (1) The model estimate shows its R Square value of 0,319 representing the value of coefficient of determination. This means that 31,90% of the variable variations of the NPF are capable of being described by free variables in this model. The remaining 68,10% is explained by other reasons that do not fit into the model; (2) A regression model on the independent variable simultaneously affects the dependent variable, so that the independent variable regression model can be used to predict the dependent variable; and (3) Inflation and BI Rate significantly influence on NPF, but CAR and FDR have no impact on NPF.

Abstract: In array pattern synthesis, the main objective is to find an appropriate weighting vector and layout of the elements to yield the desired radiation pattern. Evolutionary techniques, such us genetic algorithms (GAs), Particle swarm optimization (PSO), simulated annealing (SA) are finding the popularity within electromagnetic community as design tools and problem solvers because of their versatility and ability to optimize in complex multimodal search spaces applied to non-differentiable cost function. Fuzzy genetic algorithms (FGAs) are a standard GAs whose control parameters are adjusted dynamically depending on best performances measures of the current population. In this paper we present a comparative study between a fuzzy genetic algorithm (FGA) and PSO for the synthesis of the amplitude radiation pattern of a linear antenna array. [Copyright &y& Elsevier]

This paper presents a rigorous synthesis of circular arrays of printed antennas using a hybrid fuzzy-genetic algorithm. Fuzzy logic based controllers are applied to fine-tune dynamically the crossover and mutation probability in the genetic algorithms, in an attempt to improve the algorithm performance. The FGA approach is compared with the Standard Genetic Algorithm (SGA), Included synthesis example clearly demonstrates that while the SGA approach gives satisfactory solutions for the problem, the FGA method usually performs significantly better. [ABSTRACT FROM AUTHOR]

Summary Objective: To determine the impact after 2 years of a water and health education (W/HE) programme on ocular Chlamydia trachomatis infection and trachoma.Methods: We randomized 12 trachoma-endemic communities in Maradi, Niger 1:1 to W/HE intervention and control arms and collected data on 10 of the 12 villages. In the intervention villages, at least one clean water well was constructed, and a 3 month, modest health education programme was provided immediately prior to the 2 year survey. We censused all households, and 557 children ages 1-5 years were randomly selected as sentinel children and examined at baseline and at one and 2 years from baseline. Trachoma was clinically assessed and a swab taken and analyzed for C. trachomatis. Tetracycline eye ointment was provided to all children in either arm during the surveys who had signs of trachoma.Results: Infection with C. trachomatis declined slightly, and not significantly, in the children in the control villages over the 2 years, from 15% to 11%. The decline in infection was more pronounced, and significant, in the children in the intervention villages, from 26% to 15%. However, the change in infection rates in the intervention villages was not significantly different from the change in infection rates in the control villages (P = 0.39, and 0.11 for change from baseline to 1 year and 2 year, respectively). There was also no difference in the change in overall trachoma rates between the two arms.Conclusion: These data suggest that the provision of water plus a modest health education programme did not result in a significant difference in trachoma or ocular C. trachomatis infection in endemic communities in Niger. A more substantial health education intervention is likely necessary to produce change. [ABSTRACT FROM AUTHOR]

The objective of this study was to test the effects of dietary natural zeolite (clinoptilolite) on performance, skin and liver histology in rats. In this study, 24 10-week-old, weaned, adult male Spraque-Dawley rats with approximately 306 +- 18.93 g initial live weight were used. The rats were randomly divided into four groups with three replicates, including a control group and groups with one of three doses of clinoptilolite (2%, 4%, and 6%) in their diets. All the rats were fed these concentrates throughout the experimental period of 56 days. The animals were reared individually in stainless steel cages. There were no significant differences in the primary and secondary follicle numbers among groups, but the diameters of each follicle were found to be significant. The primary and secondary follicle numbers and diameters ranged from lowest to highest as follows: 2.00-2.33, 4.50-7.17; and 11.53-20.42, 57.63-102.12um, respectively. The differences occurred between the control group and group IV (containing 6% zeolite). In addition, the skin and liver histology results showed that there were no differences among the groups.

Background: Randomized controlled trials found that twice-yearly mass azithromycin administration (MDA) reduces childhood mortality, presumably by reducing infection burden. World Health Organization (WHO) issued conditional guidelines for mass azithromycin administration in high-mortality settings in sub-Saharan Africa given concerns for antibiotic resistance. While prolonged twice-yearly MDA has been shown to increase antibiotic resistance in small randomized controlled trials, the objective of this study was to determine if macrolide and non-macrolide resistance in the gut increases with the duration of azithromycin MDA in a larger setting., Methods and Findings: The Macrolide Oraux pour Réduire les Décès avec un Oeil sur la Résistance (MORDOR) study was conducted in Niger from December 2014 to June 2020. It was a cluster-randomized trial of azithromycin (A) versus placebo (P) aimed at evaluating childhood mortality. This is a sub-study in the MORDOR trial to track changes in antibiotic resistance after prolonged azithromycin MDA. A total of 594 communities were eligible. Children 1 to 59 months in 163 randomly chosen communities were eligible to receive treatment and included in resistance monitoring. Participants, staff, and investigators were masked to treatment allocation. At the conclusion of MORDOR Phase I, by design, all communities received an additional year of twice-yearly azithromycin treatments (Phase II). Thus, at the conclusion of Phase II, the treatment history (1 letter per 6-month period) for the participating communities was either (PP-PP-AA) or (AA-AA-AA). In Phase III, participating communities were then re-randomized to receive either another 3 rounds of azithromycin or placebo, thus resulting in 4 treatment histories: Group 1 (AA-AA-AA-AA-A, N = 51), Group 2 (PP-PP-AA-AA-A, N = 40), Group 3 (AA-AA-AA-PP-P, N = 27), and Group 4 (PP-PP-AA-PP-P, N = 32). Rectal swabs from each child (N = 5,340) were obtained 6 months after the last treatment. Each child contributed 1 rectal swab and these were pooled at the community level, processed for DNA-seq, and analyzed for genetic resistance determinants. The primary prespecified outcome was macrolide resistance determinants in the gut. Secondary outcomes were resistance to beta-lactams and other antibiotic classes. Communities recently randomized to azithromycin (groups 1 and 2) had significantly more macrolide resistance determinants than those recently randomized to placebo (groups 3 and 4) (fold change 2.18, 95% CI 1.5 to 3.51, Punadj < 0.001). However, there was no significant increase in macrolide resistance in communities treated 4.5 years (group 1) compared to just the most recent 2.5 years (group 2) (fold change 0.80, 95% CI 0.50 to 1.00, Padj = 0.010), or between communities that had been treated for 3 years in the past (group 3) versus just 1 year in the past (group 4) (fold change 1.00, 95% CI 0.78 to 2.35, Padj = 0.52). We also found no significant differences for beta-lactams or other antibiotic classes. The main limitations of our study were the absence of phenotypic characterization of resistance, no complete placebo arm, and no monitoring outside of Niger limiting generalizability., Conclusions: In this study, we observed that mass azithromycin distribution for childhood mortality among preschool children in Niger increased macrolide resistance determinants in the gut but that resistance may plateau after 2 to 3 years of treatment. Co-selection to other classes needs to be monitored., Trial Registration: NCT02047981 https://classic.clinicaltrials.gov/ct2/show/NCT02047981., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Arzika et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Millions of doses of azithromycin are distributed each year for trachoma, yet the treatment efficacy of a single dose of azithromycin for ocular Chlamydia infection has not been well characterized. In this study, four villages in Niger received a mass azithromycin distribution for trachoma. All 426 children aged 0-5 years residing in the study villages were offered conjunctival swabbing every 6 months to test for ocular Chlamydia trachomatis. Among the children infected with ocular Chlamydia before treatment, 6% (95% CI: 2-15%) tested positive for ocular Chlamydia infection 6 months later, and 15% (95% CI: 7-28%) tested positive 12 months later. The most important predictor of post-treatment ocular Chlamydia infection was pretreatment ocular Chlamydia infection (relative risk: 3.5, 95% CI: 1.3-9.4). Although the 6-monthly monitoring schedule was suboptimal for testing the treatment efficacy of an antibiotic, these findings are nonetheless consistent with high treatment efficacy of a single dose of azithromycin and suggest that additional interventions might be most effective if targeted to those children infected prior to treatment.

Background: Trachomatous trichiasis (TT) is a painful, potentially blinding eye condition that can be managed through epilation or surgery. Women are affected by TT approximately twice as often as men and are believed to face gendered barriers to receiving surgical care to prevent vision loss., Methods: We used data from 817 cross-sectional surveys conducted during 2015-2019 in 20 African countries to estimate the prevalence difference (PD) between female and male eyes for four outcomes potentially indicating gender-related differences in TT management: (1) received surgery and developed postoperative TT (PTT), (2) never offered surgery, (3) offered surgery but declined it, and (4) offered epilation but never offered surgery., Results: The prevalence was modestly elevated among female eyes compared with male eyes for having PTT (PD:1.8 [95% confidence limits (CL): 0.6, 3.0]) and having declined surgery for the eye (PD: 6.2 [95% CL: 1.8, 10.7]). The proportion offered epilation was similar by gender (PD:0.5 [95% CL: -0.4, 1.3]), while never having been offered surgery was somewhat more prevalent among male eyes (PD: -2.1 [95% CL: -3.5, -0.7])., Conclusions: Our results suggest potential gender differences in TT management. More research is needed to determine the causes and implications of the observed differences., (© The Author(s) 2023. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.)

Purpose: Population-based prevalence surveys are essential for decision-making on interventions to achieve trachoma elimination as a public health problem. This paper outlines the methodologies of Tropical Data, which supports work to undertake those surveys., Methods: Tropical Data is a consortium of partners that supports health ministries worldwide to conduct globally standardised prevalence surveys that conform to World Health Organization recommendations. Founding principles are health ministry ownership, partnership and collaboration, and quality assurance and quality control at every step of the survey process. Support covers survey planning, survey design, training, electronic data collection and fieldwork, and data management, analysis and dissemination. Methods are adapted to meet local context and needs. Customisations, operational research and integration of other diseases into routine trachoma surveys have also been supported., Results: Between 29 th February 2016 and 24 th April 2023, 3373 trachoma surveys across 50 countries have been supported, resulting in 10,818,502 people being examined for trachoma., Conclusion: This health ministry-led, standardised approach, with support from the start to the end of the survey process, has helped all trachoma elimination stakeholders to know where interventions are needed, where interventions can be stopped, and when elimination as a public health problem has been achieved. Flexibility to meet specific country contexts, adaptation to changes in global guidance and adjustments in response to user feedback have facilitated innovation in evidence-based methodologies, and supported health ministries to strive for global disease control targets.

Infectious conjunctivitis outbreaks remain a public health burden. This study focuses on the pathogen and antimicrobial resistance (AMR) profiles identified in Niger. Sixty-two patients with acute infectious conjunctivitis who presented to health posts were enrolled from December 2021 to May 2022. Nasal and conjunctival swabs were obtained from each patient. Unbiased RNA deep sequencing (RNA-seq) was used to identify associated pathogens. A pathogen was identified in 39 patients (63%; 95% CI, 50-74). Of those, an RNA virus was detected in 23 patients (59%; 95% CI, 43-73). RNA viruses were diverse and included human coronaviruses (HCoVs): SARS-CoV-2, HCoV-229E, HCoV-HKU1, and HCoV-OC43. A DNA virus was identified in 11 patients (28%; 95% CI, 17-44). Of those, four patients had a coinfection with an RNA virus and two patients had a coinfection with both an RNA virus and a bacterium. DNA viruses were predominantly human herpesvirus (cytomegalovirus, Epstein-Barr virus, human herpesvirus 8) and human adenovirus species B, C, and F. Eighteen patients (46%; 95% CI, 32-61) had a bacteria-associated infection that included Haemophilus influenza, Haemophilus aegyptius, Staphylococcus aureus, Streptococcus pneumoniae, and Moraxella spp. Antimicrobial resistance determinants were detected in either the conjunctiva or nasal samples of 20 patients (32%; 95% CI, 22-45) and were found to be more diverse in the nose (Shannon alpha diversity, 1.12 [95% CI, 1.05-1.26] versus 1.02 [95% CI, 1.00-1.05], P = 0.01). These results suggest the potential utility of leveraging RNA-seq to surveil pathogens and AMR for ocular infections.

Background: Trachoma is the commonest infectious cause of blindness worldwide. Efforts are being made to eliminate trachoma as a public health problem globally. However, as prevalence decreases, it becomes more challenging to precisely predict prevalence. We demonstrate how model-based geostatistics (MBG) can be used as a reliable, efficient, and widely applicable tool to assess the elimination status of trachoma., Methods: We analysed trachoma surveillance data from Brazil, Malawi, and Niger. We developed geostatistical Binomial models to predict trachomatous inflammation-follicular (TF) and trachomatous trichiasis (TT) prevalence. We proposed a general framework to incorporate age and gender in the geostatistical models, whilst accounting for residual spatial and non-spatial variation in prevalence through the use of random effects. We also used predictive probabilities generated by the geostatistical models to quantify the likelihood of having achieved the elimination target in each evaluation unit (EU)., Results: TF and TT prevalence varied considerably by country, with Brazil showing the lowest prevalence and Niger the highest. Brazil and Malawi are highly likely to have met the elimination criteria for TF in each EU, but, for some EUs, there was high uncertainty in relation to the elimination of TT according to the model alone. In Niger, the predicted prevalence varied significantly across EUs, with the probability of having achieved the elimination target ranging from values close to 0% to 100%, for both TF and TT., Conclusions: We demonstrated the wide applicability of MBG for trachoma programmes, using data from different epidemiological settings. Unlike the standard trachoma prevalence survey approach, MBG provides a more statistically rigorous way of quantifying uncertainty around the achievement of elimination prevalence targets, through the use of spatial correlation. In addition to the analysis of existing survey data, MBG also provides an approach to identify areas in which more sampling effort is needed to improve EU classification. We advocate MBG as the new standard method for analysing trachoma survey outputs., Competing Interests: AB and SB are employed by the International Trachoma Initiative, which receives an operating budget and research funding from Pfizer Inc., the manufacturers of Zithromax (azithromycin). EMHE receives salary support from the International Trachoma Initiative., (Copyright: © 2023 Sasanami et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Trachoma, caused by ocular Chlamydia trachomatis infection, is targeted for global elimination as a public health problem by 2030. To provide evidence for use of antibodies to monitor C. trachomatis transmission, we collated IgG responses to Pgp3 antigen, PCR positivity, and clinical observations from 19,811 children aged 1-9 years in 14 populations. We demonstrate that age-seroprevalence curves consistently shift along a gradient of transmission intensity: rising steeply in populations with high levels of infection and active trachoma and becoming flat in populations near elimination. Seroprevalence (range: 0-54%) and seroconversion rates (range: 0-15 per 100 person-years) correlate with PCR prevalence (r: 0.87, 95% CI: 0.57, 0.97). A seroprevalence threshold of 13.5% (seroconversion rate 2.75 per 100 person-years) identifies clusters with any PCR-identified infection at high sensitivity ( >90%) and moderate specificity (69-75%). Antibody responses in young children provide a robust, generalizable approach to monitor population progress toward and beyond trachoma elimination., (© 2023. The Author(s).)

Background: Trachoma is the leading infectious cause of blindness. To reduce transmission, water, sanitation, and hygiene (WaSH) improvements are promoted through a comprehensive public health strategy. Evidence supporting the role of WaSH in trachoma elimination is mixed and it remains unknown what WaSH coverages are needed to effectively reduce transmission., Methods/findings: We used g-computation to estimate the impact on the prevalence of trachomatous inflammation-follicular among children aged 1-9 years (TF1-9) when hypothetical WaSH interventions raised the minimum coverages from 5% to 100% for "nearby" face-washing water (<30 minutes roundtrip collection time) and adult latrine use in an evaluation unit (EU). For each scenario, we estimated the generalized prevalence difference as the TF1-9 prevalence under the intervention scenarios minus the observed prevalence. Data from 574 cross-sectional surveys conducted in 16 African and Eastern Mediterranean countries were included. Surveys were conducted from 2015-2019 with support from the Global Trachoma Mapping Project and Tropical Data. When modeling interventions among EUs that had not yet met the TF1-9 elimination target, increasing nearby face-washing water and latrine use coverages above 30% was generally associated with consistent decreases in TF1-9. For nearby face-washing water, we estimated a ≥25% decrease in TF1-9 at 65% coverage, with a plateau upon reaching 85% coverage. For latrine use, the estimated decrease in TF1-9 accelerated from 80% coverage upward, with a ≥25% decrease in TF1-9 by 85% coverage. Among EUs that had previously met the elimination target, results were inconclusive., Conclusions: Our results support Sustainable Development Goal 6 and provide insight into potential WaSH-related coverage targets for trachoma elimination. Targets can be tested in future trials to improve evidence-based WaSH guidance for trachoma., Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: AB is employed by the International Trachoma Initiative at The Task Force for Global Health, which receives an operating budget and research funds from Pfizer Inc., the manufacturers of Zithromax (azithromycin); EMHE is funded by the International Trachoma Initiative, a program of The Task Force for Global Health, which receives funding from Pfizer Inc., the manufacturers of Zithromax (azithromycin). All other authors have no completing interests to declare., (Copyright: © 2023 Sullivan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Importance: Because transmission of ocular strains of Chlamydia trachomatis is greatest among preschool-aged children, limiting azithromycin distributions to this age group may conserve resources and result in less antimicrobial resistance, which is a potential advantage in areas with hypoendemic trachoma and limited resources., Objective: To determine the efficacy of mass azithromycin distributions to preschool-aged children as a strategy for trachoma elimination in areas with hypoendemic disease., Design, Setting, and Participants: In this cluster randomized clinical trial performed from November 23, 2014, until July 31, 2017, thirty rural communities in Niger were randomized at a 1:1 ratio to biannual mass distributions of either azithromycin or placebo to children aged 1 to 59 months. Participants and study personnel were masked to treatment allocation. Data analyses for trachoma outcomes were performed from October 19, 2021, through June 10, 2022., Interventions: Every 6 months, a single dose of either oral azithromycin (20 mg/kg using height-based approximation for children who could stand or weight calculation for small children) or oral placebo was provided to all children aged 1 to 59 months., Main Outcomes and Measures: Trachoma was a prespecified outcome of the trial, assessed as the community-level prevalence of trachomatous inflammation-follicular and trachomatous inflammation-intense through masked grading of conjunctival photographs from a random sample of 40 children per community each year during the 2-year study period. A secondary outcome was the seroprevalence of antibodies to C trachomatis antigens., Results: At baseline, 4726 children in 30 communities were included; 1695 children were enrolled in 15 azithromycin communities and 3031 children were enrolled in 15 placebo communities (mean [SD] proportions of boys, 51.8% [4.7%] vs 52.0% [4.2%]; mean [SD] age, 30.8 [2.8] vs 30.6 [2.6] months). The mean coverage of study drug for the 4 treatments was 79% (95% CI, 75%-83%) in the azithromycin group and 82% (95% CI, 79%-85%) in the placebo group. The mean prevalence of trachomatous inflammation-follicular at baseline was 1.9% (95% CI, 0.5%-3.5%) in the azithromycin group and 0.9% (95% CI, 0-1.9%) in the placebo group. At 24 months, trachomatous inflammation-follicular prevalence was 0.2% (95% CI, 0-0.5%) in the azithromycin group and 0.8% (95% CI, 0.2%-1.6%) in the placebo group (incidence rate ratio adjusted for baseline: 0.18 [95% CI, 0.01-1.20]; permutation P = .07)., Conclusions and Relevance: The findings of this trial do not show that biannual mass azithromycin distributions to preschool-aged children were more effective than placebo, although the underlying prevalence of trachoma was low. The sustained absence of trachoma even in the placebo group suggests that trachoma may have been eliminated as a public health problem in this part of Niger., Trial Registration: ClinicalTrials.gov Identifier: NCT02048007.

Background: Global elimination of trachoma as a public health problem was targeted for 2020. We reviewed progress towards the elimination of active trachoma by country and geographical group., Methods: In this retrospective analysis of national survey and implementation data, all countries ever known to be endemic for trachoma that had either implemented at least one trachoma impact survey shown in the publicly available Trachoma Atlas, or are in Africa were invited to participate in this study. Scale-up was described according to the number of known endemic implementation units and mass drug administration implementation over time. The prevalence of active trachoma-follicular among children aged 1-9 years (TF 1-9 ) from baseline, impact, and surveillance surveys was categorised and used to show programme progress towards reaching the elimination threshold (TF 1-9 <5%) using dot maps, spaghetti plots, and boxplots., Findings: We included data until Nov 10, 2021, for 38 countries, representing 2097 ever-endemic implementation units. Of these, 1923 (91·7%) have had mass drug administration. Of 1731 implementation units with a trachoma impact survey, the prevalence of TF 1-9 had reduced by at least 50% in 1465 (84·6%) implementation units and 1182 (56·4%) of 2097 ever-endemic implementation units had reached the elimination threshold. 2 years after reaching a TF 1-9 prevalence below 5%, most implementation units sustained this target; however, 58 (56·3%) of 103 implementation units in Ethiopia showed recrudescence., Interpretation: Global elimination of trachoma as a public health problem by 2020 was not possible, but this finding masks the great progress achieved. Implementation units in high baseline categories and recrudescent TF 1-9 might prolong the attainment of elimination of active trachoma. Elimination is delayed but, with an understanding of the patterns and timelines to reaching elimination targets and a commitment toward meeting future targets, global elimination can still be achieved by 2030., Funding: None., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.)