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BACKGROUND:After approximately 5 years of SAFE (surgery, antibiotics, facial cleanliness, environmental improvement) interventions for trachoma, hyperendemic (trachomatous inflammation-follicular (TF) ≥30%) districts remained in Amhara, Ethiopia. This study's aim was to characterize the epidemiology of Chlamydia trachomatis (Ct) infection and load among pre-school aged children living under the SAFE strategy. METHODS:Conjunctival swabs from a population-based sample of children aged 1-5 years collected between 2011 and 2015 were assayed to provide Ct infection data from 4 endemic zones (comprised of 58 districts). Ct load was determined using a calibration curve. Children were graded for TF and trachomatous inflammation-intense (TI). RESULTS:7,441 children were swabbed in 4 zones. TF and TI prevalence were 39.9% (95% confidence Interval [CI]: 37.5%, 42.4%), and 9.2% (95% CI: 8.1%, 10.3%) respectively. Ct infection prevalence was 6.0% (95% CI: 5.0%, 7.2%). Infection was highest among children aged 2 to 4 years (6.6%-7.0%). Approximately 10% of infection occurred among children aged 1 year. Ct load decreased with age (P = 0.002), with the highest loads observed in children aged 1 year (P = 0.01) vs. aged 5 years. Participants with TF (P = 0.20) and TI (P

BackgroundWorld Health Organization (WHO) recommendations for starting and stopping mass antibiotic distributions are based on a clinical sign of trachoma, which is indirectly related to actual infection with the causative agent, Chlamydia trachomatis.MethodsThis study aimed to understand the effect of SAFE (surgery, antibiotics, facial cleanliness, and environmental improvement) interventions on ocular chlamydia in Amhara, Ethiopia, by describing the infection prevalence in a population-based sample of children aged 1-5 years. Trachoma surveys were conducted in all districts of Amhara, from 2011 to 2015 following approximately 5 years of SAFE. Ocular swabs were collected from randomly selected children to estimate the zonal prevalence of chlamydial infection. The Abbott RealTime polymerase chain reaction assay was used to detect C. trachomatis DNA.ResultsA total of 15632 samples were collected across 10 zones of Amhara. The prevalence of chlamydial infection in children aged 1-5 years was 5.7% (95% confidence interval, 4.2%-7.3%; zonal range, 1.0%-18.5%). Chlamydial infection and trachomatous inflammation-intense (TI) among children aged 1-9 years were highly correlated at the zonal level (Spearman correlation [r] = 0.93; P < .001), while chlamydial infection and trachomatous inflammation-follicular were moderately correlated (r = 0.57; P = .084).ConclusionsAfter 5 years of SAFE, there is appreciable chlamydial infection in children aged 1-5 years, indicating that transmission has not been interrupted and that interventions should continue. The sign TI was highly correlated with chlamydial infection and can be used as a proxy indicator of infection.

Diarrhea is a leading cause of death among children aged less than five years globally. Most studies of pediatric diarrhea rely on caregiver-reported stool consistency and frequency to define the disease. Research on the validity of caregiver-reported diarrhea is sparse. We collected stool samples from 2,398 children participating in two clinical trials in the Amhara region of Ethiopia. The consistency of each stool sample was graded by the child's caregiver and two trained laboratory technicians according to an illustrated stool consistency scale. We assessed the reliability of graded stool consistency among the technicians, and then compared the caregiver's grade with the technician's grade. We also tested if the illustrated stool consistency scale could improve the validity of caregiver's report. The weighted kappa measuring the agreement between the two laboratory technicians reached 0.90 after 500 stool samples were graded. The sensitivity of caregiver-reported loose or watery stool was 15.5% (95% confidence interval [CI]: 9.7, 24.2) and the specificity was 98.4% (95% CI 97.1, 99.1). With the illustrated scale, the sensitivity was 68.5% (95% CI: 58.5, 77.1) and the specificity was 86.1% (95% CI: 79.3, 90.9). The results indicate that caregiver-reported stool consistency using the terms "loose or watery" does not accurately describe stool consistency as graded by trained laboratory technicians. Given the predominance of using caregiver-reported stool consistency to define diarrheal disease, the low sensitivity identified in this study suggests that the burden of diarrheal disease may be underestimated and intervention effects could be biased. The illustrated scale is a potential low-lost tool to improve the validity of caregiver-reported stool consistency.

Latrines are the most basic form of improved sanitation and are a common public health intervention. Understanding motivations for building and using latrines can help develop effective, sustainable latrine promotion programs. We conducted a mixed-methods study of latrine use in the Amhara region of Ethiopia. We held 15 focus group discussions and surveyed 278 households in five communities. We used the Integrated Behavioral Model for Water, Sanitation, and Hygiene interventions to guide our qualitative analysis. Seventy-one percent of households had a latrine, but coverage varied greatly across communities. Higher household income was not associated with latrine use (odds ratio [OR] = 1.9; 95% confidence interval [CI] = 0.5, 7.7); similarly, cost and availability of materials were not discussed as barriers to latrine use in the focus groups. Male-headed households were more likely to use latrines than households with female heads (OR = 3.5; 95% CI = 1.6, 7.7), and households with children in school were more likely to use latrines than households without children in school (OR = 2.3; 95% CI = 1.6, 3.3). These quantitative findings were confirmed in focus groups, where participants discussed how children relay health messages from school. Participants discussed how women prefer not to use latrines, often finding them strange or even scary. These findings are useful for public health implementation; they imply that community-level drivers are important predictors of household latrine use and that cost is not a significant barrier. These findings confirm that school-aged children may be effective conduits of health messages and suggest that latrines can be better marketed and designed for women.

BackgroundFace cleanliness is a core component of the SAFE (Surgery, Antibiotics, Facial cleanliness, and Environmental improvements) strategy for trachoma control. Understanding knowledge, attitudes, and behaviors related to face washing may be helpful for designing effective interventions for improving facial cleanliness.MethodsIn April 2014, a mixed methods study including focus groups and a quantitative cross-sectional study was conducted in the East Gojjam zone of the Amhara region of Ethiopia. Participants were asked about face washing practices, motivations for face washing, use of soap (which may reduce bacterial load), and fly control strategies.ResultsOverall, both knowledge and reported practice of face washing was high. Participants reported they knew that washing their own face and their children's faces daily was important for hygiene and infection control. Although participants reported high knowledge of the importance of soap for face washing, quantitative data revealed strong variations by community in the use of soap for face washing, ranging from 4.4% to 82.2% of households reporting using soap for face washing. Cost and forgetfulness were cited as barriers to the use of soap for face washing. Keeping flies from landing on children was a commonly cited motivator for regular face washing, as was trachoma prevention.ConclusionsInterventions aiming to improve facial cleanliness for trachoma prevention should focus on habit formation (to address forgetfulness) and address barriers to the use of soap, such as reducing cost. Interventions that focus solely on improving knowledge may not be effective for changing face-washing behaviors.

Objective To investigate, in Amhara, Ethiopia, the association between prevalence of active trachoma among children aged 1-9 years and community sanitation usage. Methods Between 2011 and 2014, prevalence of trachoma and household pit latrine usage were measured in five population-based cross-sectional surveys. Data on observed indicators of latrine use were aggregated into a measure of community sanitation usage calculated as the proportion of households with a latrine in use. All household members were examined for clinical signs, i.e. trachomatous inflammation, follicular and/or intense, indicative of active trachoma. Multilevel logistic regression was used to estimate prevalence odds ratios (OR) and 95% confidence intervals (CI), adjusting for community, household and individual factors, and to evaluate modification by household latrine use and water access. Findings In surveyed areas, prevalence of active trachoma among children was estimated to be 29% (95% CI: 28-30) and mean community sanitation usage was 47% (95% CI: 45-48). Despite significant modification (p < 0.0001), no pattern in stratified ORs was detected. Summarizing across strata, community sanitation usage values of 60 to < 80% and [greater than or equal to] 80% were associated with lower prevalence odds of active trachoma, compared with community sanitation usage of < 20% (OR: 0.76; 95% CI: 0.57-1.03 and OR: 0.67; 95% CI: 0.48-0.95, respectively). Conclusion In Amhara, Ethiopia, a negative correlation was observed between community sanitation usage and prevalence of active trachoma among children, highlighting the need for continued efforts to encourage higher levels of sanitation usage and to support sustained use throughout the community, not simply at the household level. Objectif Etudier dans la region Amhara, en Ethiopie, l'association entre la prevalence du trachome actif chez les enfants ages de 1 a 9 ans et l'utilisation d'installations d'assainissement collectif. Methodes Entre 2011 et 2014, la prevalencedu trachome et l'utilisation de latrines a fosse domestiques ont ete mesurees dans le cadre de cinq enquetes transversales menees aupres de la population. Les donnees sur les indicateurs observes concernant l'utilisation de latrines ont ete regroupees dans une mesure de l'utilisation des installations d'assainissement collectif exprimee comme la proportion de menages utilisant des latrines. Tous les membres des menages ont fait l'objet d'un examen destine a detecter les signes cliniques, c'est-a-dire une inflammation trachomateuse folliculaire et/ou intense, revelateurs d'un trachome actif. Une regression logistique a plusieurs niveaux a ete utilisee pour estimer le rapport de cote (RC) de prevalence ainsi que les intervalles de confiance (IC) a 95%, en tenant compte de facteurs lies a la communaute, aux menages et aux individus, et pour evaluer les variations induites par l'utilisation de latrines domestiques et un acces a l'eau. Resultats Dans les zones etudiees, la prevalence du trachome actif chez les enfants a ete estimee a 29% (IC a 95%: 28-30) et l'utilisation moyenne des installations d'assainissement collectif a 47% (IC a 95%: 45-48). Malgre des variations considerables (p < 0,0001), aucune tendance liee aux RC stratifies ne s'est degagee. Pour resumer en tenant compte des differentes strates, lorsque les valeurs relatives a l'utilisation des installations d'assainissement collectif etaient comprises entre 60 et 80% ou [greater than or equal to] 80%, le rapport de cote de prevalence du trachome actif etait plus faible que lorsque les valeurs relatives a l'utilisation des installations d'assainissement collectif etaient Conclusion Dans la region Amhara de l'Ethiopie, une correlation negative a ete observee entre l'utilisation dlnstallations d'assainissement collectif et la prevalence du trachome actif chez les enfants, soulignant la necessite de poursuivre les efforts pour encourager l'utilisation dlnstallations d'assainissement et promouvoir une utilisation durable dans l'ensemble de la population, et non seulement au niveau des menages. Objetivo Investigar, en Amhara, Etiopia, la relacion entre la prevalencia del tracoma activo en ninos de entre 1 y 9 anos y el uso comunitario del saneamiento. Metodos Entre 2011 y 2014, se midieron la prevalencia del tracoma y el uso domestico de las letrinas de pozo en cinco encuestas transversales basadas en la poblacion. Los datos sobre los indicadores observados del uso de letrinas se agregaron en una medida del uso del saneamiento comunitario calculado como el porcentaje de hogares con una letrina en uso. Se examino a todos los miembros del hogar en busca de sintomas clinicos, es decir, inflamacion tracomatosa, folicular y/o intensa, indicio de tracoma activo. Se utilizo una regresion logistica de varios niveles para estimar la prevalencia de los cocientes de posibilidades (CP) y los intervalos de confianza (IC) del 95%, ajustandose a factores comunitarios, domesticos e individuales, y para evaluar la modificacion por uso de letrinas y acceso al agua en los hogares. Resultados En las zonas encuestadas, se estimo que la prevalencia del tracoma activo en ninos era del 29% (IC del 95%: 28-30) y que el uso comunitario del saneamiento era del 47% (IC del 95%: 45-48). A pesar de una importante modificacion (p < 0,0001), no se detecto ningun patron en los CP estratificados. Como resumen de los estratos, los valores de uso comunitario del saneamiento del 60 al < 80% y [greater than or equal to] 80% se relacionaron con una menor prevalencia de tracoma activo, en comparacion con un uso comunitario del saneamiento de, Introduction It has been estimated that, as a result of trachoma, approximately 1.2 million people are blind and a further 1.7 million have low vision. (1) Globally, trachoma remains the [...]

Background School surveys provide a convenient platform to obtain large child cohorts from multiple communities and are widely used as a proxy to determine community prevalence of neglected tropical diseases. The purpose of this study was to compare trachoma prevalence between preschool- and school-aged children and children who attend and do not attend school. Methods We analysed data from community-based trachoma surveys conducted from 2008–2011 in Ethiopia, Mali, Niger and Nigeria. The surveys utilised a cross-sectional, randomised cluster design. Individual-level data on school attendance was collected. Results Overall, 75 864 children aged 1-15 years from 2100 communities were included in the analysis. The prevalence of trachomatous inflammation follicular (TF) among these children in surveyed districts was 19.1% (95% CI 17.9–20.2%) in Ethiopia, 6.2% (95% CI 5.4–6.9%) in Niger, 4.6% (95% CI 4.2–4.9%) in Mali and 4.2% (95% CI 3.5–4.9%) in Nigeria. Controlling for age, sex and clustering, the OR of TF for school-attendees compared to non-attendees was 0.64 (95% CI 0.56–0.73) in Ethiopia, 0.67 (95% CI 0.56–0.80) in Mali, 1.03 (95% CI 0.81–1.16) in Niger and 1.06, (95% CI 0.65–1.73) in Nigeria. Conclusion Estimating the prevalence of trachoma through examination of only school-going children risks underestimating the true prevalence. [ABSTRACT FROM PUBLISHER]