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.

Exploring water, sanitation, and hygiene coverage targets for reaching and sustaining trachoma elimination: G-computation analysis.

BACKGROUND: Trachoma is the leading infectious cause of blindness. To reduce transmission, water, sanitation, and hygiene (WaSH) improvements are promoted through a comprehensive public health strategy. Evidence supporting the role of WaSH in trachoma elimination is mixed and it remains unknown what WaSH coverages are needed to effectively reduce transmission. METHODS/FINDINGS: We used g-computation to estimate the impact on the prevalence of trachomatous inflammation-follicular among children aged 1-9 years (TF1-9) when hypothetical WaSH interventions raised the minimum coverages from 5% to 100% for "nearby" face-washing water (<30 minutes roundtrip collection time) and adult latrine use in an evaluation unit (EU). For each scenario, we estimated the generalized prevalence difference as the TF1-9 prevalence under the intervention scenarios minus the observed prevalence. Data from 574 cross-sectional surveys conducted in 16 African and Eastern Mediterranean countries were included. Surveys were conducted from 2015-2019 with support from the Global Trachoma Mapping Project and Tropical Data. When modeling interventions among EUs that had not yet met the TF1-9 elimination target, increasing nearby face-washing water and latrine use coverages above 30% was generally associated with consistent decreases in TF1-9. For nearby face-washing water, we estimated a ≥25% decrease in TF1-9 at 65% coverage, with a plateau upon reaching 85% coverage. For latrine use, the estimated decrease in TF1-9 accelerated from 80% coverage upward, with a ≥25% decrease in TF1-9 by 85% coverage. Among EUs that had previously met the elimination target, results were inconclusive. CONCLUSIONS: Our results support Sustainable Development Goal 6 and provide insight into potential WaSH-related coverage targets for trachoma elimination. Targets can be tested in future trials to improve evidence-based WaSH guidance for trachoma.

[Pediatric cataract: Epidemiological, etiological, clinical and therapeutic features at the Yaounde gyneco-obstetrics and pediatric hospital]. / Cataracte de l'enfant : aspects épidémiologiques, étiologiques, cliniques et thérapeutiques à l'hôpital gynéco-obstétrique et pédiatrique de Yaoundé.

INTRODUCTION: The number of blind children in the world is approximately 1.5 million, a large proportion of which is attributable to congenital cataracts. Our goal is to describe the epidemiological, etiological, clinical and therapeutic aspects of childhood cataracts at the Yaoundé Gyneco-Obstetrics and Pediatric Hospital (YGOPH). MATERIAL AND METHODS: This is a retrospective, descriptive study of cataracts diagnosed in children under 16 years of age from January 2010 to December 2017. Variables analyzed were age, sex, reason for consultation, laterality and duration of symptoms, type of cataract and treatment administered. RESULTS: We collected 82 patient records. The sex ratio was 1.56. The most frequent age group was 0-4 years at 42.5% (34), and the mean age was 6.6 years (1 day-15 years). The main reasons for consultation were decreased visual acuity in 46.3% (37) and leukocoria in 37.5% (30). Cataracts were unilateral in 72% (59) of the cases. The most common onset of the cataracts was congenital (40.8%) (31), and traumatic cataracts accounted for 27.6% (21). Mature white cataracts accounted for 39% (32), predominantly congenital etiologies in 41.5% (34). Cataract surgery was performed in 33 eyes. Small incision cataract surgery was the most common technique at 51.5% (17). CONCLUSION: Pediatric cataracts are relatively rare. Identification of risk factors may help decrease their incidence.

Pattern of corneal pathologies in children seen at Yaoundé Gynaeco-Obstetric and Paediatric Hospital, Cameroon.

PURPOSE: To describe the different corneal pathologies and determine the prevalence of corneal blindness amongst children aged 0-15 years, seen at the ophthalmology unit of a tertiary hospital in Cameroon. PATIENTS AND METHODS: The medical records of all patients who presented to the Ophthalmic Unit between 2002 and 2010 were reviewed, retrospectively. The records of children aged 0-15 years, presenting with corneal pathologies, were further reviewed. Data collected included age, sex, past medical history, initial visual acuity, type of corneal lesion, and visual acuity at last follow-up. RESULTS: Of the 7,922 children seen over the study period, 168 had corneal pathologies: a prevalence of 2.1%. Males were more affected than females (male to female ratio: 1.4:1; P = 0.008). The age range was from 2 weeks to 15 years (mean age: 7.1 years; standard deviation: 4.4 years). The leading etiologies were trauma (48.2%; n = 81) and infection (28.0%; n = 47). Amongst those with available follow-up data, visual impairment and blindness occurred in 50% of the cases (n = 12), with one case being bilateral. CONCLUSION: Trauma is the most frequent cause of corneal blindness in children.

[Tropical endemic limboconjunctivitis (vernal conjunctivitis) in northern Cameroon]. / La limboconjonctivite endémique des tropiques au nord Cameroun.

INTRODUCTION: A retrospective study was conducted in the ophthalmology unit of the Garoua regional hospital on children examined from January 2001 to December 2007. We aimed to determine the epidemiological aspects of tropical endemic limboconjunctivitis in northern Cameroon. Included were all the files of patients aged 0-15 years seen with a positive diagnosis of tropical endemic limboconjunctivitis. The data analyzed were obtained through inspection, interview, and a comprehensive ocular exam done for every case, assessing far visual acuity, slit lamp biomicroscopy, and funduscopy when possible. The variables analyzed were age, sex, signs and symptoms, residential area, associated pathologies, and the month and the year of the diagnosis. The data were analyzed with Epi-Info, version 6.04d (French) and the results compared with the Chi(2) test with a 95% confidence interval. RESULTS: A total of 6453 children were included: 2036 had a positive diagnosis of tropical endemic limboconjunctivitis, with a frequency of 31.55%. The mean age was 6.5 years. The 1- to 4-year-old age group had the highest number of patients, with a frequency of 33.25%. There were 1120 males (55%). Itching was the most frequent complaint encountered in 60.90% of the patients. Ocular involvement was always bilateral. Tropical endemic limboconjunctivitis is an allergic conjunctivitis present throughout the year with two peaks in March and July. DISCUSSION: Tropical endemic limboconjunctivitis can be considered an allergic conjunctivitis affecting boys more frequently than girls in warm and dry environments. It is frequent in children less than 5 years old and regresses with age. CONCLUSION: Tropical endemic limboconjunctivitis is a tropical disease with an intertropical aspect.

[Clinical and epidemiological characteristics of chronic open angle glaucoma at a Yaoundé Hospital]. / Caractéristiques cliniques et épidémiologiques du glaucome chronique à angle ouvert.

UNLABELLED: This retrospective study examined the files of patients who consulted at the Women's and Children's Hospital of Yaoundé in Cameroon from March 2003 through December 2006. The main objective was to determine the epidemiological and clinical characteristics of patients diagnosed with chronic open-angle glaucoma (COAG). RESULTS: Of 8,123 files reviewed, 184 patients (54.3% women) were diagnosed with COAG, all but one binocular. Their mean age was 62.2+/-13.01 years. According to the WHO definition of blindness, the rate of bilateral blindness was 34.2%, that of unilateral blindness 21% and low vision 17.4%. Significant statistic correlations were observed between the cup depth of the optic disc and visual acuity on one hand, and between the level of intraocular pressure and cup depth on the other, p=0.0001. Approximately 90.67% of the eyes with glaucoma had high pressure and 9.23% normal pressure. DISCUSSION: COAG is a major cause of visual disability in Cameroon. Intraocular pressure is an important risk factor, but its positive predictive value for the impairment of optic disc fibres is low (R=0.29); other factors (apoptosis and ischemia of the optic disc) are associated with it. CONCLUSION: Advanced strategies for early diagnosis of COAG are essential, for this disease is an important cause of blindness. Such programmes would significantly delay the onset of visual disabilities.