Accuracy, acceptability and feasibility of photography for use in trachoma surveys: a mixed methods study in Tanzania.

BACKGROUND: Photography could be used to train individuals to diagnose trachomatous inflammation-follicular (TF) as trachoma prevalence decreases and to ensure accurate field TF grading in trachoma prevalence surveys. We compared photograph and field TF grading and determined the acceptability and feasibility of eyelid photography to community members and trachoma survey trainers. METHODS: A total of 100 children ages 1-9 y were examined for TF in two Maasai villages in Tanzania. Two images of the right everted superior tarsal conjunctiva of each child were taken with a smartphone and a digital single-lens reflex (DSLR) camera. Two graders independently graded all photos. Focus group discussions (FGDs) were conducted with community members and Tropical Data trainers. RESULTS: Of 391 photos, one-fifth were discarded as ungradable. Compared with field grading, photo grading consistently underdiagnosed TF. Compared with field grading, DSLR photo grading resulted in a higher prevalence and sensitivity than smartphone photo grading. FGDs indicated that communities and trainers found photography acceptable and preferred smartphones to DSLR in terms of practicalities, but image quality was of paramount importance for trainers. CONCLUSIONS: Photography is acceptable and feasible, but further work is needed to ensure high-quality images that enable accurate and consistent grading before being routinely implemented in trachoma surveys.

Trachoma Rapid Assessments in Venezuela, an Example of the Integration of Data Gathering with Service Delivery in Hard-to-reach Populations.

A) PURPOSE: The objective of the study was to assess the presence of trachoma in high priority districts in the Amazon state of Venezuela (the Bolivarian Republic of), and use trachoma data gathering platform to offer integrated primary health care services to underserved hard-to-reach populations living in the border with Colombia. B) METHODS: Trachoma Rapid Assessments (TRA) were conducted in indigenous communities of three municipalities of the Amazonas State of Venezuela from June 2018 to April 2019 using the World Health Organization (WHO) guidelines. Integrated health services were delivered based on the identified needs of the population of the assessed communities. C) RESULTS: 1,185 children aged 1-9 years were examined for trachoma in the three municipalities, of which 6.92% had active trachoma; 994 people 15 years and above were examined for trachomatous trichiasis (TT) finding two cases (0.2%). 1,635 people were examined for other health-related problems and the most common diagnoses were intestinal parasites (54.74%), eye diseases (16.81%), cavities (7.34%), scabies (5.56%), headache (4.40%), and malaria (2.81%); additionally, 2,233 vaccine doses were provided to children and adults to complete vaccination series. D) CONCLUSION: The results of the TRA in the Amazon state of Venezuela suggest that trachoma could be a public health problem and standardized population-based surveys to establish the prevalence and determine the interventions to implement are needed.

Lessons from the Field: Integrated survey methodologies for neglected tropical diseases.

The 2021-2030 Neglected Tropical Diseases road map calls for intensified cross-cutting approaches. By moving away from vertical programming, the integration of platforms and intervention delivery aims to improve efficiency, cost-effectiveness and programme coverage. Drawing on the direct experiences of the authors, this article outlines key elements for successful integrated surveys, the challenges encountered, as well as future opportunities and threats to such surveys. There are multiple advantages. Careful planning should ensure that integration does not result in a process that is less efficient, more expensive or that generates data driving less reliable decisions than conducting multiple disease-specific surveys.

Prevalence of trachoma and associated factors in the rural area of the department of Vaupés, Colombia.

OBJECTIVES: The objectives of the study were to estimate the prevalence of different clinical signs of trachoma and identify possible factors associated with TF. METHODOLOGY: Following the approval of the study protocol by the ethics committee, a cross-sectional study was conducted in Vaupés, a department of the Colombian Amazon, between the years 2012 and 2013 in two districts. Based on the records obtained from a standardized format for the clinical evaluation of the participants and the factors associated with follicular trachoma, an excel database was built and debugged, which was analyzed using IBM SPSS, Statistics Version 23 and Stata STATA (Version 14, 2015, StataCorp LLC, Texas, USA). RESULTS: The records of 13,091 individuals was collected from 216 rural indigenous communities, of which 12,080 were examined (92.3%); 7,274 in the Western and 4,806 in the Eastern districts. A prevalence of trachomatous inflammation-follicular (TF) of 21.7% (n = 599; 95% CI 20.2-23.3) in the Western and 24.9% (n = 483; 95% CI 23.1-26.9) in the Eastern district was found in children aged 1 to 9 years. Regarding trachomatous trichiasis (TT), 77 cases were found, of which 14 belonged to the Western district (prevalence 0.3%, CI 95% 0.2-0.5) and 63 to the Eastern district (1.8%, CI 95% 1.4-2.4). Children aged between 1 to 9 years were significantly more likely to have TF when there was the presence of secretions on the face (OR: 3.2; 95% CI: 2.6-3.9). CONCLUSIONS: Trachoma is a public health problem in Vaupés that requires the implementation of the SAFE strategy (S = Surgery, A = Antibiotics, F = Face Washing, E = Environment) in the Eastern and Western districts, for at least 3 consecutive years, in accordance with WHO recommendations.

Potential Effect of Epilation on the Outcome of Surgery for Trachomatous Trichiasis.

PURPOSE: To evaluate the association of epilation before surgery on the surgical outcome in trachomatous trichiasis (TT) patients. METHODS: As a secondary data analysis, 1452 patients enrolled in the STAR trial were categorized according to preoperative epilation status. The main outcome was recurrent trichiasis after surgery. We used multivariable analysis, time-to-event analysis, and Cox proportional hazards model. RESULTS: Those who epilated prior to surgery tended to be older and female, with worse entropion at baseline. The proportion with postoperative trichiasis was 7.7%, 8.8% in those who epilated versus 5.3% in those who did not (P = 0.03). Adjusting for age and sex, the risk of postoperative TT with epilation was 1.71 (P value = 0.02). Although entropion may be in the biological pathway from epilation to postoperative TT, we adjusted for entropion, and the risk of postoperative TT with epilation was 1.41 (P = 0.14). CONCLUSIONS: The study suggests that preoperative epilation may increase the risk of postoperative trichiasis. Further research is needed to confirm the finding. TRANSLATIONAL RELEVANCE: Patients with TT often self-treat, epilating their inturned eyelashes. The World Health Organization recommends surgery to treat TT, but when patients refuse the procedure or mild trichiasis is present, epilation is often recommended. There is some evidence that repetitive or improper epilation can be harmful to the lid and hair follicles. If there is damage to the lid margin, any subsequent surgery could have deleterious outcomes.