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Interventions to reduce the prevalence of trachoma and transmission of ocularWe use a two-stage cluster-sampling cross-sectional survey design. In each EU, 26 clusters (villages) were systematically selected with probability proportional to size; from each cluster, 30 households were selected using compact segment sampling. Water, sanitation and hygiene (WASH) access was assessed in all selected households. All residents of selected households aged ≥1 year were examined for TF and trachomatous trichiasis (TT) by certified graders.Of 31,991 individuals enumerated, 29,230 (91% of) individuals were examined. Eight EUs had an age-adjusted TF prevalence in 1-9-year-olds of ≥5% and seven had a TT prevalence unknown to the health system among adults aged ≥15 years of ≥0.2%. About one-third of visited households had access to an improved water source for drinking, and 5% had access to an improved latrine.Despite TF reductions to5% at impact survey, prevalence recrudesced to ≥5% in all but three of the 11 EUs. Operational research is needed to understand transmission dynamics and epidemiology, in order to optimise elimination strategies in high-transmission settings like these.

There is a clear scientific consensus that no new coal mines can be developed, if the Paris Agreement to limit global temperature rises is to be met. Yet in December 2022, following a lengthy Public Inquiry, the UK Government approved the development of Woodhouse Colliery in Cumbria. In doing so, it accepted the claim that the coal mine would be ‘zero carbon’, and could even result in lower global emissions overall. As this paper demonstrates, there is no independent evidence to support these claims, whilst a large body of independent evidence comes to the opposite conclusion. This paper uses the example of Woodhouse Colliery to examine the use of evidence and expertise in climate governance processes. It finds that the nature of expertise and evidence is not properly considered, and that there is ambiguity and confusion surrounding the implementation of the UK’s climate legislation, particularly the Climate Change Act. It also finds that the ways in which the decision-making process solicited and assessed evidence was flawed, promoting a ‘false balance’. This ambiguity and false balance provide scope for developers to argue the case for destructive developments, even while claiming adherence to climate ambitions. The paper concludes by suggesting reforms to governance processes, to provide a more transparent and credible implementation of policies to achieve the UK’s net zero target. Suggested reforms include clearer rules governing fossil fuel phase-out; greater transparency and better handling of conflicts of interest in decision-making; and devolution of climate responsibilities to local areas.

PURPOSE: To determine the prevalence of trachoma in each of the 21 local government areas (LGAs) of Adamawa State, Nigeria. METHODS: A population-based cross-sectional survey was conducted in each of the 21 LGAs of Adamawa State between 2017 and 2019. With the support of Tropical Data (TD), surveys were planned and implemented in accordance with World Health Organization (WHO) recommendations. A two-stage cluster sampling technique was used in each LGA, 25 or 30 clusters were selected with a probability of selection proportionate to cluster size, and in each of these clusters, 25 or 30 households were enrolled for the survey. All residents aged 1 year and older within selected households were examined by TD-certified graders for trachomatous inflammation - follicular (TF) and trachomatous trichiasis (TT) using the WHO simplified grading scheme. Additionally, data were collected on household water and sanitation access. RESULTS: All 21 LGAs had TF prevalence in 1-9-year-olds below 5%. The prevalence of TT unknown to the health system in people aged ≥15 years was ≥0.2% in three of the 21 LGAs. Access to improved water and sanitation facilities was

Concerns have been raised that a focus on greenhouse gas removals (GGR) in climate models, scientific literature and other media might deter measures to mitigate climate change through reduction of emissions at source – the phenomenon of ‘mitigation deterrence’. Given the urgent need for climate action, any delay in emissions reduction would be worrying. We convened nine deliberative workshops to expose stakeholders to futures scenarios involving mitigation deterrence. The workshops examined ways in which deterrence might arise, and how it could be minimized. The deliberation exposed social and cultural interactions that might otherwise remain hidden. The paper describes narratives and ideas discussed in the workshops regarding political and economic mechanisms through which mitigation deterrence might occur, the plausibility of such pathways, and measures recommended to reduce the risk of such occurrence. Mitigation deterrence is interpreted as an important example of the ‘attraction of delay’ in a setting in which there are many incentives for procrastination. While our stakeholders accepted the historic persistence of delay in mitigation, some struggled to accept that similar processes, involving GGRs, may be happening now. The paper therefore also reviews the claims made by participants about mitigation deterrence, identifying discursive strategies that advocates of carbon removal might deploy to deflect concerns about mitigation deterrence. We conclude that the problem of mitigation deterrence is significant, needs to be recognized in climate policy, and its mechanisms better understood. Based on stakeholder proposals we suggest ways of governing GGR which would maximize both GGR and carbon reduction through other means.

We aimed to estimate the prevalence of trachomatous inflammation-follicular (TF) in 1-9-year-olds and trachomatous trichiasis (TT) unknown to the health system in ≥15-year-olds in Benishangul Gumuz (BGZ) region, Ethiopia. This will help to assess progress towards the elimination of trachoma as a public health problem and determine the need for future interventions against trachoma in the region.Cross-sectional population-based trachoma prevalence surveys were conducted in four evaluation units (EUs) of BGZ using World Health Organization-recommended survey methodologies. Individuals were examined for clinical signs of trachoma. Household access to water, sanitation and hygiene facilities (WaSH) was assessed.A total of 11,778 people aged ≥1 year were examined. The prevalence of TF in 1-9-year-olds was5% in three EUs and ≥5% in one EU. The prevalence of TT unknown to the health system in people aged ≥15-years was ≥0.2% in all four EUs. The proportion of households with an improved drinking water source within a 30-minute round-trip ranged from 27-60%. The proportion of households with an improved latrine ranged from1-6%.Surgical interventions for TT are required in all EUs in BGZ. One annual round of mass drug administration (MDA) of azithromycin is required in one EU before resurvey to reassess progress in lowering TF prevalence below the WHO elimination threshold of 5% in 1-9-year-olds. MDA should be stopped in the other three EUs and trachoma surveillance surveys should be conducted at least 24 months after the surveys described here. Ongoing strengthening of WaSH infrastructure may help sustain the low prevalence of trachoma.

We set out to determine the baseline prevalence of trachoma in 13 Local Government Areas (LGAs) of Borno State, Nigeria.A population-based cross-sectional survey was conducted in each of 13 LGAs from 2017 to 2019, with the support of Tropical Data (TD). World Health Organization (WHO)-recommended protocols were used. With a probability-proportional-to-size systematic sampling method, 25 villages were selected per LGA in 2017 and 30 villages per LGA in 2019; in each village, 25 households were enrolled for 2017 surveys, while 30 were enrolled for 2019 surveys. All present, consenting residents aged ≥1 year were examined by TD-certified graders for trachomatous inflammation-follicular (TF) and trachomatous trichiasis (TT) using the WHO simplified grading scheme. Additionally, we collected data on household-level access to water, sanitation and hygiene (WASH) facilities.One LGA (Magumeri) had TF prevalence in 1-9-year-olds ≥10%; two other LGAs (Monguno and Kaga) had TF prevalence between 5.0% and 9.9%. The prevalence of TT unknown to the health system was ≥0.2% in six LGAs. The proportion of households with access to improved water sources ranged from 30% (Kwaya Kusar) to 95% (Monguno); household-level access to improved latrines was lowest in Shani (7%) and highest in Maiduguri (95%).Active TT case finding and strengthening of TT surgical services are needed in six LGAs. Mass drug administration (MDA) of antibiotics is needed in three LGAs to reduce the prevalence of active trachoma to below elimination thresholds. The trachoma elimination programme should engage WASH agencies to augment access to improved WASH facilities.

The COVID-19 imposed lockdown has led to a number of temporary environmental side effects (reduced global emissions, cleaner air, less noise), that the climate community has aspired to achieve over a number of decades. However, these benefits have been achieved at a massive cost to welfare and the economy. This commentary draws lessons from the COVID-19 crisis for climate change. It discusses whether there are more sustainable ways of achieving these benefits, as part of a more desirable, low carbon resilient future, in a more planned, inclusive and less disruptive way. In order to achieve this, we argue for a clearer social contract between citizens and the state. We discuss how COVID-19 has demonstrated that behaviours can change abruptly, that these changes come at a cost, that we need a ‘social mandate’ to ensure these changes remain in the long-term, and that science plays an important role in informing this process. We suggest that deliberative engagement mechanisms, such as citizens’ assemblies and juries, could be a powerful way to build a social mandate for climate action post-COVID-19. This would enable behaviour changes to become more accepted, embedded and bearable in the long-term and provide the basis for future climate action.

PURPOSE: Trachoma is endemic in Southern Nations, Nationalities and Peoples' (SNNP) and Sidama regions of Ethiopia. We aimed to measure the prevalence of trachomatous inflammation - follicular (TF) among children aged 1 - 9 years and the prevalence of trachomatous trichiasis (TT) unknown to the health system among people aged ≥15 years following interventions for trachoma in 52 woredas of SNNP and Sidama regions. METHODS: From 2017 - 2019, 66 two-stage cluster sampling cross-sectional population-based surveys were carried out in 52 woredas (third-level administrative divisions) using a standardized World Health Organization-recommended survey methodology. This included one impact survey in 40 woredas, two consecutive impact surveys in 10 woredas and three consecutive impact surveys in two woredas. Water, sanitation and Hygiene (WASH) access was assessed using a modified version of the United Nations Children's Fund/WHO Joint Monitoring Programme questionnaire. RESULTS: By the end of this survey series, 15 (23%) of the woredas had met the active trachoma elimination threshold (TF prevalence

No democratic state has yet implemented a climate plan strong enough to meet the goals of the Paris Agreement. This has led some to argue that democracy cannot cope with a challenge of this magnitude. In this article, we take stock of the claim that a more deliberative democratic system can strengthen our ability to respond effectively to the climate crisis. The most visible development in this direction is the recent citizens’ assemblies on climate change in Ireland, France, and the UK. We begin our analysis of the promise of deliberative democracy with a recognition of the difficulties that democracies face in tackling climate change, including short-termism; the ways in which scientific and expert evidence are used; the influence of powerful political interests; and the relationship between people and the politicians that represent them. We then introduce the theoretical tradition of deliberative democracy and examine how it might ameliorate the challenges democracies face in responding to the climate crisis. We evaluate the contribution of deliberative mini-publics, such as citizens’ assemblies and juries, and look beyond these formal processes to examine how deliberation can be embedded in political and social systems around the world. We conclude that deliberation-based reforms to democratic systems, including but not limited to deliberative mini-publics, are a necessary and potentially transformative ingredient in climate action. This article is categorized under: Perceptions, Behavior, and Communication of Climate Change > Communication Policy and Governance > Governing Climate Change in Communities, Cities, and Regions.

BACKGROUND: To determine where interventions are needed to eliminate trachoma as a public health problem, prevalence data are needed. We aimed to generate baseline population-based data on trachoma prevalence in suspected-endemic areas of Afghanistan. METHODS: Cross-sectional population-based prevalence surveys designed according to World Health Organization (WHO) recommendations were conducted in 35 evaluation units (EUs) covering 72 districts. In selected households, all resident individuals aged ≥1 year were examined for trachomatous inflammation-follicular (TF) and trachomatous trichiasis (TT) according to the WHO simplified trachoma grading system. Water, sanitation and hygiene access was assessed in households of survey participants. RESULTS: 104,104 people aged ≥1 year were examined, including 43,774 children aged 1-9 years and 46,439 people aged ≥15 years. The age-adjusted prevalence of TF in 1-9-year-olds was ≥5% in 3 EUs, with the highest EU TF prevalence being 7.8%. The age- and gender-adjusted prevalence of TT unknown to the health system in ≥15-year-olds was

To determine the prevalence of trachomatous inflammation—follicular (TF), trachomatous trichiasis (TT), water, sanitation, and hygiene (WASH) access in 131 evaluation units (EUs) after implementation of trachoma elimination interventions in Oromia Region, Ethiopia. A population-based cross-sectional survey was conducted in each EU using the World Health Organization-recommended two-stage cluster-sampling methodology. Twenty-six clusters, each with a mean of 30 households were enumerated in each EU. All residents aged ≥1 year in selected households were examined for TF and TT. Information on WASH access in surveyed households was also collected through questioning the household head and direct observation. A total of 419,858 individuals were enumerated in 131 EUs, of whom 396,134 (94%) were examined, 54% being female. Age-adjusted EU-level prevalence of TF in children aged 1–9 years ranged from 0.15% (95% confidence interval [CI]: 0.0–0.4) to 37.5% (95% CI: 31.1–43.7). The TF prevalence was

Researchers using deliberative techniques tend to favour in-person processes. However, the COVID-19 pandemic has added urgency to the question of whether meaningful deliberative research is possible in an online setting. This paper considers the reasons for taking deliberation online, including bringing people together more easily; convening international events; and reducing the environmental impact of research. It reports on four case studies: a set of stakeholder workshops considering greenhouse gas removal technologies, convened online in 2019, and online research workshops investigating local climate strategies; as well as two in-person processes which moved online due to COVID-19: Climate Assembly UK, a Citizens’ Assembly on climate change, and the Lancaster Citizens’ Jury on Climate Change. It sets out learnings from these processes, concluding that deliberation online is substantively different from in-person meetings, but can meet the requirements of deliberative research, and can be a rewarding and useful process for participants and researchers alike.

Purpose: To assess the contemporary prevalence of trachoma in Brazil���s non-indigenous population, surveys of those thought to be at greatest risk of disease were conducted. Methods: Rural census tracts of non-indigenous population from nine mesoregions were selected to compose the survey evaluation units (EUs) by considering previously endemic municipalities at greatest risk of trachoma. In each of the nine EUs, we conducted a population-based prevalence survey. Every resident of selected households aged ���1 year was examined for trachomatous inflammation ��� follicular (TF) and trachomatous trichiasis (TT). Additionally, data were collected on household-level access to water, sanitation, hygiene (WASH) and education. Results: A total of 27,962 individuals were examined across nine EUs. The age-adjusted TF prevalence in 1���9-year-olds was 99% of surveyed children. Conclusions: The prevalence of TF was well below the target for elimination as a public health problem in all EUs. Because EUs surveyed were selected to represent the highest-risk non-indigenous areas of the country, TF prevalence is unlikely to be ���5% in non-indigenous populations elsewhere. In one EU, the prevalence of TT was above the target threshold for elimination. Further investigation and possibly improvement in TT surgical provision are required in that EU.

Purpose: Previous phases of trachoma mapping in Pakistan completed baseline surveys in 38 districts. To help guide national trachoma elimination planning, we set out to estimate trachoma prevalence in 43 suspected-endemic evaluation units (EUs) of 15 further districts. Methods: We planned a population-based trachoma prevalence survey in each EU. Two-stage cluster sampling was employed, using the systems and approaches of the Global Trachoma Mapping Project. In each EU, residents aged ≥1 year living in 30 households in each of 26 villages were invited to be examined by trained, certified trachoma graders. Questionnaires and direct observation were used to evaluate household-level access to water and sanitation. Results: One EU was not completed due to insecurity. Of the remaining 42, three EUs had trichiasis prevalence estimates in ≥15-year-olds ≥0.2%, and six (different) EUs had prevalence estimates of trachomatous inflammation—follicular (TF) in 1–9-year-olds ≥5%; each EU requires trichiasis and TF prevalence estimates below these thresholds to achieve elimination of trachoma as a public health problem. All six EUs with TF prevalences ≥5% were in Khyber Pakhtunkhwa Province. Household-level access to improved sanitation ranged by EU from 6% to 100%. Household-level access to an improved source of water for face and hand washing ranged by EU from 37% to 100%. Conclusion: Trachoma was a public health problem in 21% (9/42) of the EUs. Because the current outbreak of extremely drug-resistant typhoid in Pakistan limits domestic use of azithromycin mass drug administration, other interventions against active trachoma should be considered here.

The scientific case for co-ordinated global governance of the climate system is firmly established, but how does this fit with a politician’s mandate as a democratically elected representative? What role do national politicians think they can and should play in climate governance? This paper tests these questions empirically, using data from interviews with 23 Members of the UK Parliament, and a focus group of civil society advocates, conducted between 2016 and 2018. A global goal to limit climate change has been agreed through the 2015 Paris Agreement. Yet while the Agreement sets a clear goal, the means to achieve it remain firmly at the level of the nation-state, with each country assuming responsibility for its own national plan. Thus national administrations, run by elected politicians, have a crucial role to play. This study shows that, while Members of the UK Parliament have an understanding of the challenges posed by climate change and wider changes to earth systems, few have yet been able to operationalise this understanding into meaningful responses at the national level. The study highlights two, linked, reasons for this. First, politicians’ ability to act – their agency – is limited by the practicalities and procedures of everyday politics, and by the norms and cultures of their working life. Second, UK politicians feel little pressure from their electors to act on climate change, and have to work to justify why action on climate change carries democratic legitimacy. The paper concludes with a discussion of the implications of this research, in the light of the recent high-profile climate protests and declarations of a ‘climate emergency’. It argues that politicians, working with other stakeholders, need support in order to articulate the scale and significance of global climate governance, and craft responses which build democratic support for further action.

Purpose To estimate the proportion of children with trachomatous inflammation—follicular (TF) and adults with trachomatous trichiasis (TT) in internally displaced persons (IDP) camps in the Darfur States of Sudan and to evaluate associated risk factors. Methods IDP camps were identified from government census data. We conducted a subanalysis of data collected in these camps during 2014–2015 as part of surveys covering 37 districts of the Darfur States within the Global Trachoma Mapping Project. A random-effects hierarchical model was used to evaluate factors associated with TF in children or TT in adults. Results Thirty-six IDP camps were represented in the survey data, in which 1926 children aged 1–9 y were examined, of whom 38 (8%) had TF. Poor sanitation, younger age and living in a household that purchased water from a vendor were associated with TF in children aged 1–9 y. Of 2139 individuals examined aged ≥15 y, 16 (0.7%) had TT. TT was strongly independently associated with being older and living alone. Conclusion Trachoma is found at low levels in these camps, but still at levels where intervention is needed. Disease elimination in conflict-related settings presents a unique challenge for the trachoma community, and may require an innovative approach. Understanding how best to undertake trachoma elimination interventions in these areas should be prioritized.

In this session speakers will present their research on deliberative democracy and public engagement in policy making followed by discussion.

A global goal to limit dangerous climate change has been agreed through the 2015 Paris Accords. The scientific case for action has been accepted by nearly all governments, at national and local or state level. Yet in all legislatures, there is a gap between the stated climate ambitions and the implementation of the measures necessary to achieve them. This paper examines this gap by analysing the experience of the following three UK cities: Belfast, Edinburgh, and Leeds. Researchers worked with city officials and elected representatives, using interviews and deliberative workshops to develop their shared understandings. The study finds that local actors employ different strategies to respond to the stated climate emergency, based on their innate understanding, or ‘phronetic knowledge’, of what works. It concludes that rapid climate action depends not just on the structures and mechanisms of governance, but at a deeper level, the assumptions, motivations and applied knowledge of decision-makers.

INTRODUCTION: The prevalence of trachomatous inflammation - follicular (TF) in 1-9-year-olds and of trachomatous trichiasis (TT) in ≥15-year-olds in four endemic evaluation units (EUs) of Darfur region, Sudan, was measured more than a year after the required single round of antibiotic mass drug administration (MDA). METHODS: Surveys were conducted using highly standardised, World Health Organization-recommended methodologies. Individuals aged ≥1 year, resident in selected households, were chosen for the survey using a two-stage cluster sampling process. Consenting adults and children were examined for the signs TF and TT by graders trained to international standards. Prevalence of disease in key indicator groups was calculated and weighted to the underlying population structure. RESULTS: A mean of 1,415 (range: 1,253-1,611) children aged 1-9 years were examined in each EU. The age-adjusted prevalence of TF in 1-9-year-olds in each of the four surveyed EUs was

Following the release of the Intergovernmental Panel on Climate Change (IPCC) 1.5 &deg, C Special Report in October 2018, there has been a surge in public concern about climate change and demands for greater government action. We analyse the discourse of Members of Parliament (MPs) on climate change on Twitter to examine the extent to which these recent public climate-related events have influenced political agenda-setting. We argue that these events have had two, linked, effects: increased political discourse on climate change, and an increasing use of &lsquo, urgent&rsquo, climate language. However, the language style used between political parties differs. Additionally, while the youth strikes and Greta Thunberg, who initiated these strikes, appear to have the greatest influence on MPs&rsquo, discourse, the overall relative impact is low, with responses predominately from left- and centrist-political parties. This indicates a clear difference between parties. However, Twitter may not be a suitable platform for investigating Conservative discourse. Further work to explore agenda-setting on Conservative policymaking is required.

Scientists are clear that urgent action is needed on climate change, and world leaders agree. Yet climate issues barely trouble domestic politics. This book explores a central dilemma of the climate crisis: science demands urgency; politics turns the other cheek. Is it possible to hope for a democratic solution to climate change? Based on interviews with leading politicians and activists, and the author's twenty years on the frontline of climate politics, this book explores why climate is such a challenge for political systems, even when policy solutions exist. It argues that more democracy, not less, is needed to tackle the climate crisis, and suggests practical ways forward.

Background In the Solomon Islands and Vanuatu, the sign trachomatous inflammation—follicular (TF) is common, but ocular infection with Chlamydia trachomatis is not. It is therefore debatable whether azithromycin mass drug administration (MDA), the recommended antibiotic treatment strategy for trachoma’s elimination as a public health problem, is necessary in this setting. We set out to estimate what proportion of adolescents were at risk of progression of trachomatous scarring. Methods A cross-sectional survey was undertaken of all children aged 10–14 years resident in communities identified as high-TF clusters during previous population-based mapping. Graders examined children for clinical evidence of trachomatous scarring, pannus, and Herbert’s pits (HPs) or limbal follicles in both eyes. A dried blood spot was collected from each child and tested for antibodies to C. trachomatis. Results A total of 492 children in 24 villages of the Solomon Islands and Vanuatu were examined. In total, 35/492 (7%) of children had limbal signs (pannus and/or HPs) plus any conjunctival scarring. And 9/492 (2%) had limbal signs and moderate or severe conjunctival scarring; 22% of children were anti-Pgp3 seropositive. Conclusions Few adolescents here are at risk of future complications from trachoma, supporting the conclusion that further antibiotic MDA is not currently required for trachoma elimination purposes in these settings., In Solomon Islands and Vanuatu communities in which active trachoma prevalence in children was previously high, prevalence of Herbert’s pits or pannus plus conjunctival scarring in 10–14-year-olds is low, suggesting risk of future trachomatous blindness here is also low.

Author(s): Duale, Ahmed Badei; Negussu Ayele, Nebiyu; Macleod, Colin K; Kello, Amir Bedri; Eshetu Gezachew, Zelalem; Binegdie, Amsalu; Dejene, Michael; Alemayehu, Wondu; Flueckiger, Rebecca M; Massae, Patrick A; Willis, Rebecca; Kebede Negash, Biruck; Solomon, Anthony W; Global Trachoma Mapping Project | Abstract: PurposeEthiopia is highly trachoma endemic. Baseline mapping was needed in Ethiopia's Somali Region to guide elimination efforts.MethodsCross-sectional community-based surveys were conducted in 34 suspected trachoma-endemic woredas, grouped as 14 evaluation units (EUs), using a standardised mapping methodology developed for the Global Trachoma Mapping Project.ResultsIn total, 53,467 individuals were enumerated. A total of 48,058 (89.9%) were present at the time of survey teams' visits and consented to examination. The prevalence of trachomatous inflammation-follicular (TF) among children aged 1-9 years ranged from 4.1% in the EU covering Danot, Boh, and Geladin woredas in Doolo Subzone to 38.1% in the EU covering Kebribeyah and Hareshen woredas in Fafan Subzone (East). The trichiasis prevalence among adults aged over 15 years varied from 0.1% in the EU covering Afder, Bare, and Dolobay woredas in Afder Subzone (West) to 1.2% in the EU covering Awbere in Fafan Subzone (West).ConclusionMass drug administration (MDA) with azithromycin is needed in 13 EUs (population 2,845,818). Two EUs (population 667,599) had TF prevalences in 1-9-year-olds of ≥30% and will require at least 5 years of MDA; 5 EUs (population 1,1193,032) had TF prevalences of 10-29.9% and need at least three years of MDA; 6 EUs (population 985,187) had TF prevalences of 5-9.9% and need at least one round of azithromycin distribution before re-survey. In all 13 of these EUs, implementation of facial cleanliness and environmental improvement measures is also needed. Surveys are still needed in the remaining 34 unmapped woredas of Somali Region.

Author(s): Tesfazion, Andeberhan; Zecarias, Alem; Zewengiel, Solomon; Willis, Rebecca; Mebrahtu, Goitom; Capa, Eva; Mpyet, Caleb; Al-Khatib, Tawfik; Courtright, Paul; Solomon, Anthony W | Abstract: PurposeTo 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).MethodsFor 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.ResultsOne 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.ConclusionInterventions 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.

Purpose: To determine the prevalence of and risk factors for trachoma in selected local government areas (LGAs) of Kwara State, Nigeria. Methodology: Population-based cross-sectional surveys were conducted in eight LGAs of Kwara State using Global Trachoma Mapping Project (GTMP) protocols. In each LGA, 25 villages were selected using probability-proportional-to-size sampling; 25 households were selected from each village using compact segment sampling. All residents of selected households aged ≥1 year were examined by GTMP-certified graders for trachomatous inflammation—follicular (TF) and trichiasis using the simplified trachoma grading scheme. Water, sanitation, and hygiene (WASH) data were also collected. Results: A total of 28,506 residents were enumerated in 4769 households across the eight LGAs. TF prevalence in children aged 1–9 years ranged from 0.2% (95% CI 0.0–0.3%) to 1.3% (95% CI 0.7–2.1%), while trichiasis prevalence in persons ≥15 years was

Purpose: A number of previous administrative-district-level baseline trachoma prevalence estimates in Zambia required verification. We used methodologies and systems for trachoma surveys considered to represent international best practice in order to generate reliable estimates of the prevalence of trachoma. Methods: Between March 2016 and July 2017, we undertook 32 population-based prevalence surveys covering 47 administrative districts. In each of the 32 evaluation units (EUs), we selected 31 households in each of 24 clusters. In selected households, trained, certified graders examined all residents aged 1 year and above for evidence of trachomatous inflammation—follicular (TF) and trichiasis. In eyes that had trichiasis, the presence or absence of trachomatous scarring (TS) was recorded, and the subject was asked about previous trichiasis management recommendations from health workers. Results: Five EUs (encompassing seven administrative districts) had prevalence estimates of trichiasis+TS unknown to the health system in ≥15-year-olds of ≥0.2%, and require public-health-level implementation of trichiasis surgery services. Eleven EUs (encompassing 16 administrative districts) had TF prevalence estimates in 1–9-year-olds of ≥5%. Intervention with the A, F and E components of the SAFE strategy for trachoma elimination is required for nearly 1.5 million people. Conclusion: Trachoma is a public health problem in some parts of Zambia. The Ministry of Health will continue to partner with other stakeholders to implement the multi-sectoral SAFE strategy. Consideration should be given to re-surveying other suspected-endemic administrative districts in which surveys using older methodologies returned TF prevalence estimates ≥5%.

Author(s): Mpyet, Caleb; Tagoh, Selassie; Boisson, Sophie; Willis, Rebecca; Muhammad, Nasiru; Bakhtiari, Ana; Adamu, Mohammed D; Pavluck, Alexandre L; Umar, Murtala M; Alada, Joel; Isiyaku, Sunday; Adamani, William; Jande, Betty; Olobio, Nicholas; Solomon, Anthony W; Global Trachoma Mapping Project | Abstract: PurposeWe sought to determine the prevalence of trachoma in each local government area (LGA) of Benue State, Nigeria.MethodsTwo-stage cluster sampling was used to conduct a series of 23 population-based prevalence surveys. LGAs were the evaluation units surveyed. In each LGA, 25 households were selected in each of 25 clusters, and individuals aged 1 year and above resident in those households were invited to be examined for trachoma. Data on access to water and sanitation were also collected at household level.ResultsA total of 91,888 people were examined from among 93,636 registered residents across the 23 LGAs. The LGA-level prevalence of trachomatous inflammation-follicular (TF) in 1-9 year olds ranged from 0.3% to 5.3%. Two LGAs had TF prevalences of 5.0-9.9%. The LGA-level prevalence of trichiasis in ≥15-year-olds ranged from 0.0% to 0.35%. Access to improved drinking water sources ranged from 0% in Gwer West to 99% in Tarka, while access to improved sanitation ranged from 1% in Gwer West to 92% in Oturkpo.ConclusionThere is a need for public health-level interventions against trachoma in three LGAs of Benue State.

Purpose: We aimed to estimate the prevalence of trachomatous inflammation—follicular (TF) in children aged 1–9 years, trichiasis in adults aged ≥15 years, and water and sanitation (WASH) indicators in 12 suspected-endemic districts in Uganda. Methods: Surveys were undertaken in 14 evaluation units (EUs) covering 12 districts. Districts were selected based on a desk review in 2014 (four districts) and trachoma rapid assessments in 2018 (eight districts). We calculated that 1,019 children aged 1–9 years were needed in each EU to estimate TF prevalence with acceptable precision and used three-stage cluster sampling to select 30 households in each of 28 (2014 surveys) or 24 (2018 surveys) villages. Participants living in selected households aged ≥1 year were examined for trachoma; thus enabling estimation of prevalences of TF in 1–9 year-olds and trichiasis in ≥15 year-olds. Household-level WASH access data were also collected. Results: A total of 11,796 households were surveyed; 22,465 children aged 1–9 years and 24,652 people aged ≥15 years were examined. EU-level prevalence of TF ranged from 0.3% (95% confidence interval [CI] 0.1–0.7) to 3.9% (95% CI 2.1–5.8). EU-level trichiasis prevalence ranged from 0.01% (95% CI 0–0.11) to 0.81% (95% CI 0.35–1.50). Overall proportions of households with improved drinking water source, water source in yard or within 1km, and improved sanitation facilities were 88.1%, 23.0% and 23.9%, respectively. Conclusion: TF was not a public health problem in any of the 14 EUs surveyed: antibiotic mass drug administration is not required in these districts. However, in four EUs, trichiasis prevalence was ≥ 0.2%, so public health-level trichiasis surgery interventions are warranted. These findings will facilitate planning for elimination of trachoma in Uganda.

Purpose: The prevalence of trichiasis is higher in females and increases markedly with age. Surveys carried out in the daytime, particularly in developing countries, are prone to find older individuals and females at home at the time of the survey. Population-level trichiasis estimates should adjust sample proportions to reflect the demographic breakdown of the population, although the most accurate method of doing this is unclear. Methods: Having obtained data from 162 surveys carried out in Ethiopia as part of the Global Trachoma Mapping Project from 2012 to 2015, we used internal validation with both Brier and Logarithmic forecast scoring to test stratification models to identify those models with the highest predictive accuracy. Selection of partitions was undertaken by both simple random sampling (SRS) and cluster sampling (CS) over 8192 selections. Results: A total of 4529 (1.9%) cases of trichiasis were identified from 241,139 individuals aged ≥15 years from a total of 4210 kebeles and 122,090 households visited. Overall, the binning method using 5-year bands from age 15 to 69 years, with coarser binning in 20-year age-bands above this age, provided the best predictive accuracy, in both SRS and CS methodologies and for both the Brier and Logarithmic scoring rules. Conclusion: The greatest predictive accuracy for trichiasis estimates was found by adjusting for sex and in 5-year age-bands from the age of 15 to 69 years and in 20-year age-bands in those aged 70 years and greater. Trichiasis surveys attempting to make population-level inferences should use this method to optimise surgery backlog estimates.

Purpose: We set out to estimate the prevalence of trachoma and access to water and sanitation in seven suspected-trachoma-endemic districts of northern Congo, surveyed as a single evaluation unit. Methods: From a complete list of rural villages in the seven districts, we systematically selected 22 with probability proportional to village size. In selected villages, we included all households where there were fewer than 25 in total, or used compact segment sampling to select a group of approximately 20 households by random draw. In each selected household, all consenting residents aged ≥1 year were examined by Global Trachoma Mapping Project-certified trachoma graders, and data collected on household-level access to water and sanitation. Results: In November and December 2015, 466 households were visited in 22 villages, and 2081 (88%) of 2377 residents of those households were examined. No examined individual had trichiasis. The age-adjusted prevalence of the active trachoma sign trachomatous inflammation—follicular (TF) in 1–9-year-olds was 2.5% (95%CI 0.9–4.5%). Only 39% (95%CI 35–44%) of households had access to an improved source of drinking water. Only 10% (95%CI 7–13%) of households had access to an improved sanitation facility. Conclusion: Trachoma is not a public health problem in this part of Congo. Access to water and sanitation is inadequate.