The impact of modified incision height and surgical procedure on trichiasis surgery outcomes: Results of the maximizing trichiasis surgery success (MTSS) randomized trial.

BACKGROUND: Poor surgical outcomes remain a problem in trachoma-endemic countries working to reach elimination thresholds. Methods to improve outcomes could positively impact programmatic success. METHODS: This parallel, three-armed clinical trial conducted in Ethiopia randomized individuals with previously unoperated trachomatous trichiasis (TT) to receive surgery utilizing one of three approaches: bilamellar tarsal rotation with a 3 mm incision height (BLTR-3), BLTR with 5 mm incision height (BLTR-5) and posterior lamellar tarsal rotation (PLTR). We followed participants for one year. The primary outcome was post-operative trichiasis (PTT). Secondary outcomes were eyelid contour abnormalities (ECA) and pyogenic granulomata. FINDINGS: We randomized and operated on 4,914 individuals with previously unoperated TT (6,940 eyes). Primary analyses include 6,815 eyes with follow-up. Overall, 1,149 (16.9%) eyes developed PTT. The risk difference for PTT was minimal comparing BLTR-3 and PLTR (adjusted risk difference [aRD] 1.8% (98.3%CI: -0.5-4.2%)), but significantly higher for BLTR-5 surgeries compared to BLTR-3 (aRD: 6.7% (3.9-9.4%)) and PLTR (aRD: 8.6% (5.9-11.3%)). BLTR-5 had the lowest ECA (6.1% versus 9.6% BLTR-3, 11.2% PLTR) and granuloma rates (5.2% versus 6.5% BLTR-3 and 7.5% PLTR). One eyelid operated with PLTR experienced an eyelid margin division; four BLTR-3 and eight BLTR-5 eyelids experienced excessive bleeding. INTERPRETATION: We do not recommend modifying the BLTR incision height of 3 mm. Overall, we did not find a significant difference in PTT between BLTR-3 and PLTR in terms of PTT or ECA. TRIAL REGISTRATION: Registration number: NCT03100747; ClinicalTrials.gov Full study protocol available at (https://doi.org/10.15139/S3/QHZXWD).

Impact of a School Trachoma Program Emphasizing Facial Cleanliness and Environmental Improvement in Amhara, Ethiopia.

The SAFE (Surgery, Antibiotics, Facial cleanliness, Environmental improvement) strategy is the WHO's endorsed approach for eliminating trachoma as a public health problem; however, not all components have been treated equally. Historically, the F and E components have not been prioritized owing to their perceived complexity. With school enrollment increasing in Ethiopia, development of a national school health program that is focused on the F and E components represents an opportunity to strengthen the SAFE strategy in the country. In 2016, the Trachoma Control Program in Amhara, Ethiopia, along with its partners, developed a School Trachoma Program (STP) that offers grade-specific lessons to improve sanitation and hygiene knowledge and practices among primary school-aged children. To assess its impact, schools were sampled before implementation and then up to 1 year after STP rollout. The aim of this report is to detail STP outcomes and the associations between outcomes and school-level variables. By 2018, adoption of an STP was strong within Amhara, with 85% of the 137 surveyed schools completing their quarterly reports and nearly 80% having at least one teacher trained in the STP. By the end of the third quarter, nearly all schools (86%) had access to a latrine, and 89% of students had a clean face. A schoolwide orientation was associated with increased STP lessons and activities (P = 0.01). Development of an STP, with buy-in from principals and teachers, represents a promising approach for the adoption of a new F- and E-specific curriculum and may help advance efforts to eliminate trachoma.

Postoperative trachomatous trichiasis and associated factors among adults who underwent trachomatous trichiasis surgery in Ambassel District, North-East Ethiopia.

BACKGROUND: In Trachoma endemic countries, many people who underwent Trichiasis surgery faced a recurrence of the disease. Postoperative Trichiasis is a significant problem for patients and health care providers because it puts the eye at renewed risk of sight loss. Despite the low utilization of Trachomatous Trichiasis surgery and the high recurrence rate, evidence that elucidate why it recurs after surgery is limited. This study was aimed to assess the magnitude and associated factors of postoperative Trichiasis among 18 years and above individuals who underwent Trachomatous Trichiasis surgery between 2013 and 2019 in Ambassel District, Northeast Ethiopia, 2020. METHODS: The community-based cross-sectional study design was conducted from March 10 to March 23/2020 in selected kebeles of Ambassel District. The required sample size (506) was calculated using EPI-INFO Version 7. A multi-stage sampling technique was used to employ study participants. Data were collected through the interviewer-administered structured pre-tested questionnaire and entered into EpiData version 3.1 and then exported to SPSS version 23.0 for analysis. Bi-variable and multivariable logistic regression models were fitted to identify associated factors of Postoperative Trachomatous Trichiasis. RESULTS: Four hundred ninety two individuals participated in this study with a response rate of 97.2%. In Ambassel district, the prevalence of postoperative Trichiasis was 23.8% (95% CI = 19.9-27.8). Among associated factors of postoperative Trachomatous Trichiasis: age 50-59 (AOR = 3.34, CI = 1.38-8.1), 60-69 (AOR = 3.24, CI = 1.38-7.61), ≥70 years (AOR = 6.04, CI = 2.23-16.41), duration since surgery (AOR = 1.7, CI = 1.35-2.14), complication (AOR = 2.98, CI = 1.24-7.2), washing the face two times (AOR = 0.25, CI = 0.13-0.47), washing the face three and more times (AOR = 0.1, CI = 0.41-0.25), taking Azithromycin following surgery (AOR = 0.19, CI = 0.09-0.41), pre-operative epilation history (AOR = 2.11, CI = 1.14, 3.9) and having a knowledge about TrachomaTtrichiasis (AOR = 0.21, CI = 0.08-0.58) showed a statistical significant association. CONCLUSIONS: The prevalence of postoperative Trichiasis in Ambassel District was higher than most Ethiopian studies. Age, frequency of face washing, medication following surgery, duration since the last surgery, knowledge about trachoma, pre-operative epilation history, and complication after surgery were identified to be independent factors. To minimize postoperative Trachomatous Trichiasis stakeholders need to consider health education for patients, provision of Azithromycin after surgery, and proper training for integrated eye care workers.

Comparison of two approaches to measuring clean faces as part of the facial cleanliness component of the SAFE trachoma elimination strategy.

BACKGROUND: The Alliance for the Global Elimination of Trachoma (GET) endorses the full SAFE strategy to eliminate trachoma; Surgery (for trichiasis), Antibiotics (to reduce the community pool of infection, Facial cleanliness, and Environmental improvement (to decrease transmission). There is no accepted measure of facial cleanliness. This study compared two possible metrics for facial cleanliness. METHOD/FINDINGS: Metric one: Clean face was defined as observed absence of ocular and nasal discharge on the face. Metric two: observing a grade of dirtiness (scale 10 = lightest to 0 = darkest) on a standard facial wipe. The reliability of grading a child's face or grading a facial wipe was determined in children in Kongwa Tanzania. We also observed both measurements in a cohort of 202 children ages 1 to <7years prior to face cleaning, immediately afterwards, and 4 hours afterwards. Fifty of the children did not have face cleaning and were controls. Intra-and interobserver reliability was similar for both measures, the latter = 0.53 for observing a clean face and 0.52 for grading a facial wipe. There was no correlation between the two. Both measures detected facial cleaning, compared to control children who were not cleaned, immediately after cleaning; control children with 53% clean faces and wipe score of 6.7 compared to cleaned children with 88% clean faces and wipe score of 8 (p = .0001, p = < .0001, respectively). Both measures also detected face washing 4 hours previously compared to controls. CONCLUSIONS: The two metrics were equally reliable, and both measured the behavior of face washing. They measure different aspects of a clean face; one measures the amount of dirt on wiped area and the other measures ocular and nasal discharge. Both measurements appear to capture the behavior of facial cleaning, and the choice of metric would appear to rest on the measurement that captures the stated objective of the behavior, consideration of costs, training, logistics, and implementation.

Navigating diagnostic and therapeutic challenges in ocular manifestations of Hansen's disease and trachoma: A narrative review.

Neglected tropical diseases (NTDs) encompass a group of approximately 20 diseases prevalent in tropical and subtropical regions, closely associated with poverty, affecting over a billion people in low-income countries. This manuscript aims to explore the ocular manifestations and burden of two significant NTDs, namely Hansen's disease and trachoma while addressing gaps in understanding and management. Hansen's disease, caused by Mycobacterium leprae , has a long history and presents with diverse neurological and ocular manifestations. Despite the availability of treatment, ocular complications persist, leading to significant visual impairment in some cases. The manuscript emphasizes the importance of early diagnosis, regular ophthalmic examinations, and follow-ups to prevent and control ocular complications, reducing the burden of visual impairment and blindness. Trachoma, caused by Chlamydia trachomatis , remains the leading infectious cause of blindness in underdeveloped and remote areas. The manuscript highlights the clinical diagnosis and implementation of the World Health Organization's (WHO's) SAFE (surgery, antibiotics, facial hygiene, and environmental sanitation) strategy to prevent transmission and associated blindness. However, challenges in health surveillance tools and underreporting of trachoma cases are addressed, emphasizing the need for improved strategies to combat the disease effectively. Through a comprehensive review of the ocular manifestations and management of Hansen's disease and trachoma, this manuscript contributes to the existing knowledge base and enhances a deeper understanding of these NTDs. Addressing gaps in understanding and management emphasizes the importance of implementing WHO's strategies and collaborative efforts to achieve the global goal of reducing the burden of NTDs and improving community health and well-being. The manuscript underscores the significance of early intervention, preventive measures, and technological advancements, providing valuable insights for policymakers, healthcare professionals, and researchers working in the field of NTDs.

Trachoma: an underdiagnosed disease revealed by a survey carried out at Jaú, São Paulo.

BACKGROUND: Trachoma is a notifiable disease in the state of São Paulo- Brazil. However, in Jaú, a municipality located in this state, in the last 10 years there are no records of cases. This study purpose is to assess if there are cases of inflammatory trachoma in schoolchildren aged 1 to 9 years in the municipality of Jaú as well if it is possible to detect clusters areas of the disease to establish elimination programs. METHODS: An epidemiological study was performed in 2018, involving a stratified random sample of schoolchildren aged 1- to 9-year-old, from public day care centers and elementary schools in the municipality of Jaú. A trachoma screening following the criteria of the World Health Organization (WHO) and the distribution of cases was assessed using geoprocessing. RESULTS: Four thousand-six hundred-nineteen children from 44 elementary schools were examined, and 126 children with active trachoma were detected, with an adjusted prevalence rate of 2.65%. The prevalence was higher (3.01%) in children aged 6- to 9-year-old compared to children aged 1-to 5-year-old (2.42%). There were clusters with a higher concentration of positive cases of the disease in three schools located in the neighborhoods with lower socioeconomic conditions. CONCLUSION: Inflammatory trachoma still present in children aged 1- to 9-year-old in the city of Jaú. The positive cases were located mainly in areas with low socioeconomic conditions. Health promotion with active search and periodical treatment must be planned to fight this important blinding cause, that persists in our municipality.

The prevention and management of postoperative trachomatous trichiasis: A systematic review.

Among ocular infections, trachoma is the main cause of blindness. Repeated conjunctival Chlamydia trachomatis infections lead to trichiasis, corneal opacification, and visual impairment. Surgery is often needed to relieve discomfort and preserve vision; however, a high postoperative trachomatous trichiasis (PTT) rate has been observed in various settings. We wanted to know why, whether PTT rates could be reduced, and how to manage the PTT that occurs. We performed a search of the literature. Of 217 papers screened, 59 studies were identified for inclusion as potentially relevant, the majority having been excluded for not directly concerning PTT in humans. Preventing PTT is a major challenge. Only one published trial, the STAR trial in Ethiopia, has reported a cumulative PTT rate <10% one year after surgery. The literature on the management of PTT is sparse. Though no PTT management guidelines are available, high-quality surgery with a low rate of unfavorable outcomes for PTT patients is likely to require enhanced training of a smaller group of highly-skilled surgeons. Based on the surgical complexity and the authors' own experience, the pathway for patients suffering from PTT should be studied further for improvement.

'Follow the cattle': a joint cross-border trachoma MDA perspective.

Trachoma, a disease caused by Chlamydia trachomatis, is the leading infectious cause of blindness. To fight it, endemic East African countries adopted the World Health Organization's SAFE Strategy, targeting surgery, antibiotics through mass drug administration (MDA), facial cleanliness and environmental improvement. Trachoma persists among nomadic communities along the Kenya-Uganda and Kenya-Tanzania borders. To address this, Kenya, Tanzania and Uganda launched synchronized MDA campaigns, simultaneously treating populations across borders. Successes included joint planning, community involvement and intergovernmental cooperation, although challenges remained in resourcing MDA cross-border focal points and in addressing coverage and funding. Novel strategies like synchronized joint cross-border MDA with community engagement are vital for sustainable trachoma elimination in these nomadic settings.

Improving data use in trachomatous trichiasis programmes: operationalisation of the TT Tracker.

Trachoma is a disease of the eye and the leading infectious cause of blindness worldwide. Years of repeated infections can cause in-turning of the lashes so that they rub against the eyeball, causing pain, discomfort and, if left untreated, blindness. This is known as trachomatous trichiasis (TT) and can be remedied by surgery. To improve oversight and reporting of TT outreach, Sightsavers developed a mobile phone application called the TT Tracker so that TT surgeons, assistants and supervisors can collect and analyse information about surgical outcomes and performance and determine when and where follow-up appointments are required. The TT Tracker is being used by seven national programmes. Examples of use and programme improvements from Nigeria, Benin and Senegal are discussed here.

Gender differences in the surgical management of trachomatous trichiasis: an exploratory analysis of global trachoma survey data, 2015-2019.

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.

Epigenetic changes induced by pathogenic Chlamydia spp.

Chlamydia trachomatis, C. pneumoniae, and C. psittaci, the three Chlamydia species known to cause human disease, have been collectively linked to several pathologies, including conjunctivitis, trachoma, respiratory disease, acute and chronic urogenital infections and their complications, and psittacosis. In vitro, animal, and human studies also established additional correlations, such as between C. pneumoniae and atherosclerosis and between C. trachomatis and ovarian cancer. As part of their survival and pathogenesis strategies as obligate intracellular bacteria, Chlamydia spp. modulate all three major types of epigenetic changes, which include deoxyribonucleic acid (DNA) methylation, histone post-translational modifications, and microRNA-mediated gene silencing. Some of these epigenetic changes may be implicated in key aspects of pathogenesis, such as the ability of the Chlamydia spp. to induce epithelial-to-mesenchymal transition, interfere with DNA damage repair, suppress cholesterol efflux from infected macrophages, act as a co-factor in human papillomavirus (HPV)-mediated cervical cancer, prevent apoptosis, and preserve the integrity of mitochondrial networks in infected host cells. A better understanding of the individual and collective contribution of epigenetic changes to pathogenesis will enhance our knowledge about the biology of Chlamydia spp. and facilitate the development of novel therapies and biomarkers. Pathogenic Chlamydia spp. contribute to epigenetically-mediated gene expression changes in host cells by multiple mechanisms.

Potential mitigating role of ivermectin on the spread of Chlamydia trachomatis by Musca sorbens.

Trachoma is the world's most frequent cause of blindness from an infectious agent. The disease caused by infection is associated with lack of access to sanitation and low hygiene standards. Trachoma is controlled through the Surgery, Antibiotics, Facial cleanliness, and Environmental improvement (SAFE) strategy, which delivers azithromycin (AZM) mass drug administration (MDA) in endemic areas. The putative vector Musca sorbens principally reproduce in human faecal matter left in the environment due to open defecation. Ivermectin (IVM) is on the WHO's essential medicines list and is administered as preventative chemotherapy against two neglected tropical diseases (NTDs)-onchocerciasis, as an annual or bi-annual treatment, and lymphatic filariasis, as an annual treatment in combination with albendazole. Ivermectin has a known inhibitive effect on insects that reproduce in dung. To assess if IVM could be a viable vector control tool against M. sorbens, this study evaluates existing data from trachoma, onchocerciasis and lymphatic filariasis mass drug administration (MDA) operations in Ethiopia. Persistent and recrudescent trachoma in evaluation units (EUs) were examined for whether AZM MDA in EUs was accompanied by IVM MDA, and whether co-administration was associated with greater likelihood of trachoma control. Results show an association suggesting that EUs that received both IVM and AZM MDA benefit from improved control of trachoma in persistent or recrudescent areas, when compared to EUs that received AZM MDA. This initial investigation supports the potential for ivermectin's use to support SAFE. Findings warrant further work to validate ivermectin's impact on M. sorbens reproduction through controlled lab and field-based studies.

Prevalence and associated factors of active trachoma among 1-9 years of age children in Andabet district, northwest Ethiopia, 2023: A multi-level mixed-effect analysis.

BACKGROUND: Trachoma is the chief cause of preventable blindness worldwide and has been earmarked for elimination as a public health problem by 2030. Despite the five-year Surgery, Antibiotics, Facial cleanliness, and Environmental improvement (SAFE)-based interventions in the Andabet district, the prevalence of trachomatous follicular (TF) was 37%. With such a high prevalence of TF, the determinant factors were not revealed. Besides, there were no reports on the overall prevalence of active trachoma (i.e.TF and or trachomatous intense (TI)). OBJECTIVE: To determine the prevalence and associated factors of active trachoma among 1-9 years of age children in the Andabet district. METHOD: A community-based cross-sectional study was conducted among children aged under nine years from March 1-30, 2023 in Andabet district, Northwest Ethiopia. Multi-stage systematic random sampling was employed to reach 540 children. A multilevel mixed-effect logistic regression analysis was employed to assess factors associated with active trachoma. We fitted both random effect and fixed effect analysis. Finally, variables with p<0.05 in the multivariable multilevel analysis were claimed to be significantly associated with active trachoma. RESULT: In this study, the overall prevalence of active trachoma was 35.37% (95% CI: 31.32%, 39.41%). The prevalence of TF and TI was 31.3% and 4.07% respectively. In the multilevel logistic regression analysis ocular discharge, fly-eye contact, latrine utilization, and source of water were significantly associated with the prevalence of active trachoma. CONCLUSION: In this study, the prevalence of active trachoma was much higher than the World Health Organization (WHO) threshold prevalence. Ocular discharge, fly-eye contact, latrine utilization, and source of water were independent determinants of active trachoma among children (1-9 years). Therefore, paying special attention to these high-risk groups could decrease the prevalence of a neglected hyperendemic disease, active trachoma.

Impact of personal protective equipment on the clarity of vision among trachoma survey graders and trichiasis surgeons in the context of COVID-19.

BACKGROUND/AIMS: The COVID-19 pandemic necessitated the use of personal protective equipment for those involved in trachoma survey grading and trichiasis surgery. We sought to determine which configuration of a face shield would be less likely to impact grading accuracy and ability to conduct trichiasis surgery. The research also included assessment of comfort, ease of cleaning and robustness. METHODS: There were three research phases. In phase 1, assessment of four potential face shield configurations was undertaken with principal trachoma graders and trichiasis surgeon trainers to decide which two options should undergo further testing. In phase 2, clarity of vision and comfort (in a classroom environment) of the two configurations were assessed compared with no face shield (control), while grading trachomatous inflammation-follicular (TF). The second phase also included the assessment of impact of the configurations while performing trichiasis surgery using a training model. In phase 3, face shield ease of use was evaluated during routine surgical programmes. RESULTS: In phase 2, 124 trachoma graders and 28 trichiasis surgeons evaluated the 2 face shield configurations selected in phase 1. TF agreement was high (kappa=0.83 and 0.82) for both configurations compared with not wearing a face shield. Comfort was reported as good by 51% and 32% of graders using the two configurations. Trichiasis skill scores were similar for both configurations. CONCLUSION: The face shield configuration that includes a cut-out for mounting the 2.5× magnifying loupes does not appear to impact the ability or comfort of trachoma graders or trichiasis surgeons to carry out their work.

Trachoma prevention practice and associated factors among mothers having children aged under nine years in Andabet district, northwest Ethiopia, 2022: A multi-level analysis.

BACKGROUND: The world health organization (WHO) adopted the Surgery, Antibiotic, facial cleanliness, and environmental improvement (SAFE) strategy for the prevention of trachoma, and different prevention strategies have been employed in Andabet district. Trachoma still has a high prevalence despite these efforts. So, it is imperative to assess ground trachoma prevention practice (TPP) since there are insufficient studies in the study area. OBJECTIVE: To determine the magnitude and factors associated with TPP among mothers having children aged under nine years in Andabet district, Northwest Ethiopia. METHOD: A community-based cross-sectional study involving 624 participants was conducted June 1-30, 2022. Systematic random sampling was carried out to select study participants. Multi-level binary logistic regression analysis was used to identify factors associated with poor TPP. Descriptive and summary statistics were performed and variables with p-value < 0.05 in the best-fitted model were declared to be significantly associated with poor TPP. RESULTS: In this study, the proportion of poor TPP was found to be 50.16% (95%CI = 46.23, 54.08). In the multi-variable multi-level logistic regression; having no formal education (AOR = 2.95; 95%CI: 1.41,6.15) and primary education (AOR = 2.33; 95%CI:1.04, 5.24), being a farmer (AOR = 3.02; 95%CI:1.73,5.28), and merchant (AOR = 2.63; 95%CI:1.20, 5.75), time taken to water point >30 minutes (AOR = 4.60,95CI:1.30,16.26) and didn't receive health education about trachoma (AOR = 2.36;95CI:1.16,4.79) were significantly associated with poor TPP. CONCLUSION: The proportion of poor TPP was high relative to other studies. Level of education, occupation, time taken to the water point, and health education were significantly associated with poor TPP. Therefore, taking special attention to these high-risk groups could decrease the poor TPP.

Trachoma, the world's leading infectious cause of blindness: The remaining gap in care and access to basic handwashing facilities.

PURPOSE: Trachoma, the world's leading infectious cause of blindness, has been targeted by the WHO for elimination through the SAFE strategy: surgery, antibiotics, facial cleanliness, and environmental improvement. Although significant progress has been made, there remains a gap in care. This project studied the association of geographical distribution of the remaining need for trachoma intervention and its association with access to basic handwashing facilities at home, as an indicator of water/sanitation infrastructure. We hypothesized that poor water sanitation would correspond to areas where trachoma intervention is still required. DESIGN: Retrospective analysis using the WHO Global Health Observatory. Spatial, correlation, and simple and multivariable regression analyses were used. METHODS: Using data from the WHO Global Health Observatory, a total of 194 countries were analyzed. Two choropleth maps were created, with inset maps focused on the South Pacific region, where the top 5 countries with the greatest population proportion requiring trachoma intervention are located. RESULTS: Correlations and the simple regression model of total population with access to handwashing facilities as the only risk factor were insignificant. However, the multivariable regression models with access to handwashing facilities (total, urban, and rural) and population density as risk factors for trachoma intervention were significant. CONCLUSION: Poor water/sanitation infrastructure correlates with trachoma burden. Therefore, water/sanitation infrastructure improvement is a worthwhile target in the efforts toward trachoma elimination, but further research on the association between these important public health indicators is warranted.

Postoperative trachomatous trichiasis: a systematic review and meta-analysis study.

BACKGROUND: Trachomatous trichiasis is the potential stage of trachoma in which the eyelashes scratch the surface of the globe, ultimately causing corneal opacity, visual impairment and blindness. The aim of this systematic review and meta-analysis is to obtain the pooled prevalence and associated factors of postoperative trachomatous trichiasis (PTT) in World Health Organization (WHO) trachoma-endemic regions. METHODS: An inclusive literature search was undertaken using PubMed, Cochrane Library, Science Direct and Google Scholar databases from 30 May 2022 to 28 June 2022. I2 statistics and funnel plots were used to determine heterogeneity and publication bias among included studies. A random effects model was used to estimate pooled prevalence, incidence and odds ratios (ORs) with the respective 95% confidence intervals (CIs) using RevMan 5.4 software. RESULTS: Eighteen articles were included in this meta-analysis and systematic review. The pooled prevalence of PTT was 19% (range 18-21). PTT was lower among young adults compared with old adults (OR 0.63 [95% CI 0.44 to 0.92]), single-dose oral azithromycin as compared with tetracycline eye ointment users (OR 0.82 [95% CI 0.69 to 0.99]) and minor trichiasis before surgery as compared with major trichiasis (OR 0.63 [95% CI 0.47 to 0.85]). CONCLUSIONS: The incidence of PTT was higher than the WHO's recommendation. Prescribing single-dose oral azithromycin after surgery, periodic training for trichiasis surgeons, close follow-up and health education after surgery are crucial to minimize the recurrence.Study protocol registration on PROSPERO: CRD42022336003.

Baseline Prevalence of Trachoma in Refugee Settlements in Uganda: Results of 11 Population-based Surveys.

PURPOSE: There are several settlements in the Northern and Western Regions of Uganda serving refugees from South Sudan and Democratic Republic of Congo (DRC), respectively. Trachoma prevalence surveys were conducted in a number of those settlements with the aim of determining whether interventions for trachoma are required. METHODS: An evaluation unit (EU) was defined as all refugee settlements in one district. Cross-sectional population-based trachoma prevalence survey methodologies designed to adhere to World Health Organization recommendations were deployed in 11 EUs to assess prevalence of trachomatous inflammation-follicular (TF) in 1-9-year-olds and trachomatous trichiasis (TT) unknown to the health system in ≥15-year-olds. Household-level water, sanitation and hygiene coverage was also assessed in study populations. RESULTS: A total of 40,892 people were examined across 11 EUs between 2018 and 2020. The prevalence of TF in 1-9-year-olds was <5% in all EUs surveyed. The prevalence of trachomatous trichiasis (TT) unknown to the health system in ≥15-year-olds was <0.2% in 5 out of 11 EUs surveyed and ≥0.2% in the remaining 6 EUs. A high proportion of households had improved water sources, but a low proportion had improved latrines or quickly (within a 30-minute return journey) accessible water sources. CONCLUSIONS: Implementation of the antibiotic, facial cleanliness and environmental improvement components of the SAFE strategy is not needed for the purposes of trachoma's elimination as a public health problem in these refugee settlements; however, intervention with TT surgery is needed in six EUs. Since instability continues to drive displacement of people from South Sudan and DRC into Uganda, there is likely to be a high rate of new arrivals to the settlements over the coming years. These populations may therefore have trachoma surveillance needs that are distinct from the surrounding non-refugee communities.

Case-control study of determinants of corrective upper eyelid surgery refusals among trachomatous trichiasis patients in Ethiopia.

Background: Repeated infection with Chlamydia trachomatis causes trachomatous trichiasis (TT). Surgery is the main and preferred method of treatment. However, many people decline surgery despite the availability of free services in nearby health facilities. Aimz: To identify the determinants of surgery refusal among TT patients in Ethiopia. Methods: This community-based, case-control study was conducted among 338 cases and 338 controls from 5 October to 17 December 2018. Using systematic random sampling, we selected people who had been operated on (controls) and those who refused surgery (cases) from registration documents and used a pre-tested, interviewer-administered, structured questionnaire for data collection. We used SPSS version 23 to analyse the data and used multivariate logistic regression to identify the determinants. Results: Having witnessed a poor surgical outcome [adjusted odds ratio (aOR): 3.51, 95% CI: 1.94-6.35] and lack of knowledge about TT (aOR: 1.77, 95% CI: 1.18-2.65) increased the refusal rate for surgery. Having trust in the surgeon (aOR: 0.26, 95% CI: 0.15-0.45), knowledge about eyelid surgery (aOR: 0.32, 95% CI: 0.16-0.64), long duration of trichiasis (aOR: 0.50, 95% CI: 0.31-0.79), decision-making via discussion with the family (aOR: 0.29, 95% CI: 0.13-0.64), frequent epilation (aOR: 0.31, 95% CI: 0.17-0.60), and receiving personal advice (aOR: 0.11, 95% CI: 0.04-0.28) reduced refusal rates. Conclusion: Refusing to have TT surgery was significantly related to knowledge about upper eyelid surgery, past surgical outcomes, decision-making capacity, and personal influences. Improved systems for upper eyelid surgery should be established in Ethiopia to better manage, and reduce unfavourable, surgical outcomes, and reduce surgery refusal.