District-Level Forecast of Achieving Trachoma Elimination as a Public Health Problem By 2030: An Ensemble Modelling Approach.

Assessing the feasibility of 2030 as a target date for global elimination of trachoma, and identification of districts that may require enhanced treatment to meet World Health Organization (WHO) elimination criteria by this date are key challenges in operational planning for trachoma programmes. Here we address these challenges by prospectively evaluating forecasting models of trachomatous inflammation-follicular (TF) prevalence, leveraging ensemble-based approaches. Seven candidate probabilistic models were developed to forecast district-wise TF prevalence in 11 760 districts, trained using district-level data on the population prevalence of TF in children aged 1-9 years from 2004 to 2022. Geographical location, history of mass drug administration treatment, and previously measured prevalence data were included in these models as key predictors. The best-performing models were included in an ensemble, using weights derived from their relative likelihood scores. To incorporate the inherent stochasticity of disease transmission and challenges of population-level surveillance, we forecasted probability distributions for the TF prevalence in each geographic district, rather than predicting a single value. Based on our probabilistic forecasts, 1.46% (95% confidence interval [CI]: 1.43-1.48%) of all districts in trachoma-endemic countries, equivalent to 172 districts, will exceed the 5% TF control threshold in 2030 with the current interventions. Global elimination of trachoma as a public health problem by 2030 may require enhanced intervention and/or surveillance of high-risk districts.

Global progress toward the elimination of active trachoma: an analysis of 38 countries.

BACKGROUND: Global elimination of trachoma as a public health problem was targeted for 2020. We reviewed progress towards the elimination of active trachoma by country and geographical group. METHODS: In this retrospective analysis of national survey and implementation data, all countries ever known to be endemic for trachoma that had either implemented at least one trachoma impact survey shown in the publicly available Trachoma Atlas, or are in Africa were invited to participate in this study. Scale-up was described according to the number of known endemic implementation units and mass drug administration implementation over time. The prevalence of active trachoma-follicular among children aged 1-9 years (TF1-9) from baseline, impact, and surveillance surveys was categorised and used to show programme progress towards reaching the elimination threshold (TF1-9 <5%) using dot maps, spaghetti plots, and boxplots. FINDINGS: We included data until Nov 10, 2021, for 38 countries, representing 2097 ever-endemic implementation units. Of these, 1923 (91·7%) have had mass drug administration. Of 1731 implementation units with a trachoma impact survey, the prevalence of TF1-9 had reduced by at least 50% in 1465 (84·6%) implementation units and 1182 (56·4%) of 2097 ever-endemic implementation units had reached the elimination threshold. 2 years after reaching a TF1-9 prevalence below 5%, most implementation units sustained this target; however, 58 (56·3%) of 103 implementation units in Ethiopia showed recrudescence. INTERPRETATION: Global elimination of trachoma as a public health problem by 2020 was not possible, but this finding masks the great progress achieved. Implementation units in high baseline categories and recrudescent TF1-9 might prolong the attainment of elimination of active trachoma. Elimination is delayed but, with an understanding of the patterns and timelines to reaching elimination targets and a commitment toward meeting future targets, global elimination can still be achieved by 2030. FUNDING: None.

Validation of Smartphone-Based Retinal Photography for Diabetic Retinopathy Screening.

BACKROUND AND OBJECTIVE: Screening for diabetic retinopathy (DR) is cost-effective when compared with disability loss for those who go blind in the absence of a screening program. We aimed to evaluate the sensitivity and specificity of a smartphone-based device for the screening and detection of DR. PATIENTS AND METHODS: A cross-sectional study of 220 patients with diabetes (440 eyes, all patients age 25 years or older) was completed. Tropicamide 0.5% was used for iris dilation followed by an indirect ophthalmoscopy using a 20-D lens. Retinal images were later obtained using a smartphone attached to an adaptable camera device. Retinal images permitted the visualization of the macular and papillary regions and were sent without compression via the internet to a retinal specialist for interpretation. Sensitivity and specificity were calculated for all cases and stages of DR. RESULTS: Using our standard examination method, the prevalence of DR and macular edema were 13.6% and 6.4%, respectively. With the smartphone-based retinal camera, the prevalence of DR and macular edema were 18.2% and 8.2%, respectively. Sensitivity and specificity for the detection of all stages of DR was 73.3% and 90.5%, respectively. For the detection of macular edema, sensitivity was 77.8%, and specificity was 95%. For severe nonproliferative DR (NPDR), sensitivity and specificity were 80% and 99%, respectively; for proliferative DR (PDR), they were both 100%. In the early stages of DR, specificity was 89.8% for mild NPDR and 97.1% for moderate NPDR. Sensitivity was 57.1% and 42.9%, respectively. CONCLUSION: Screening for DR using a smartphone-based retinal camera has a satisfactory specificity at all DR stages. Its sensitivity seems to be high only in the stages of DR necessitating a specific therapeutic decision (eg, macular edema, severe NPDR, and PDR). A smartphone-based retinal camera may be a useful device to screen for DR in resource-limited settings. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:S18-S22.].

Stages of development of traditional simulation unit of surgery for manual extra capsular cataract extraction in sub-Saharan African region.

The manual extracapsular extraction of the lens is the surgical technique that is most practiced for the treatment of cataract in sub-Saharan Africa. Learning this technique requires the creation of a surgical simulation unit within training institutes. We describe the development stages of a traditional simulation unit. For this purpose, we present a description of four steps involved in the development of a simulation unit for cataract surgery: the physical creation of the room, the aseptic and antisepsis conditions, the management of the eyes, the development of a curriculum and the administrative policies.

Malarial retinopathy in adult: a case report.

Although widely reported in children, the malarial retinopathy has rarely been described in adults. We observed a case in the department of ophthalmology at the pediatric and gynecology-obstetrics Yaoundé Hospital. The diagnosis revealing a decrease in visual acuity was confirmed by thorough ophthalmological and biological assessments. The basic treatment by quinine therapy was conclusive. The authors point out the need to consider this diagnosis in case of any decrease in visual acuity in febrile context for any adult living or recently having stayed in endemic areas.

Clinical and microbiological assessment of trachoma in the kolofata health district, far north region, cameroon.

BACKGROUND AND AIMS: Trachoma is a sight-threatening process triggered by the infection of the conjunctiva with Chlamydiae. Blindness associated with trachoma was reported in Sahelian areas of Cameroon. However, data on the prevalence of this neglected infection in the Far North Region are not available. The aim of this study was a) to assess clinical trachoma and b) to detect Chlamydia in the conjunctiva of trachomatous populations living in the Far North Regions of Cameroon. METHODS: A total of 2,423 randomly selected children (1-10 years) and 1,590 women over 14 from randomly selected villages from the Kolofata Health District (115,000 inhabitants) were included in a cross-sectional study in February 2009. Trained staff examined and obtained conjunctival swabs from trachomatous subjects. DNA was extracted and amplified to detect Chlamydia DNA by real-time PCR. The quality of sampling was assessed by quantifying the number of epithelial cells. RESULTS: Children (2,397 or 98.9% of the predicted number) and women (1,543; 97.0%) were examined. The prevalence of follicular trachoma (TF) in children was 21% (95% CI 17.8-24.5) and of intense inflammatory trachoma (TI) 5.2% (95% CI 3.6-7.3). Among the women, trichiasis (TT) was observed in 3.4% (95% CI 2.4-4.7), corneal opacities (CO) in 1.4% (95% CI 0.8-2.3) and trachoma-related blindness in 0.9% (95% CI 0.4-1.8). Conditions related to income, illiteracy, latrines, water supply and animals wandering close to dwellings were similar in all the villages. PCR was positive in 35% of children with active trachoma and in 6% of adult females presenting TT and/or related corneal opacities. CONCLUSION: The prevalence of trachoma and the severe trachoma sequelae found during this survey underline the urgent need to implement efficient blindness prevention interventions to improve the visual future of the people in the Sahelian region.

[Childhood ocular tumors: epidemiological and histopathological aspects at the Yaoundé gynaeco obstetric and pediatric hospital]. / Les tumeurs oculaires primitives de l'enfant : aspects épidémiologiques et histopathologiques à l'hôpital gynéco-obstétrique et pédiatrique de Yaoundé

UNLABELLED: The ocular tumours encountered in ophthalmologic consultations affect all age groups. The purpose of our study is to help improve knowledge of ocular and orbital tumours in children in Cameroon, by analysing the epidemiologic and histopathologic aspects of these tumours at the Yaoundé Gynaeco-Obstetric and Pediatric Hospital (HGOPY). We therefore conducted a retrospective descriptive cross-sectional study examining files of cases treated from 2003 through 2009. We found that tumours accounted for 0.36% of all consultations of children aged from 0 to 15 years in the HGOPY and affected an average of three children a year, mainly those younger than 10 years (90% of the cases) and 65% boys. Overall, 75% of the tumours were retinoblastomas (75%), 15% conjunctival naevi, 5% epidermoid carcinomas of conjunctiva (5%) and angioneurofibromas of the optic nerve (5%). CONCLUSION: Ocular tumours are rare in children attending hospitals in Cameroon. They are mainly retinablastinomas and affect boys more often than girls.

Blindness and visual impairment in retinitis pigmentosa: a Cameroonian hospital-based study.

AIM: We performed a retrospective, analytical study in February 2010 on all retinitis pigmentosa cases seen during ophthalmologic consultation at the Gyneco-Obstetrics and Pediatric Hospital of Yaounde between March 2002 and December 2009 (82 months). The aim of this research was to determine the significance of blindness and visual impairment associated with retinitis pigmentosa in Cameroon. RESULTS: Forty cases were reported, corresponding to a hospital prevalence of 1.6/1000 (21 men and 19 women). The average age of the patients was 43.3 +/- 18 years, ranging between 6 and 74 years. Bilateral blindness and low vision was noted in 30% and 27.5% of patients, respectively. The average age of patients with low vision was 40.38 +/- 16.27 years and the average age of those with bilateral blindness was 51.08 +/- 15.79 years. Retinitis pigmentosa was bilateral in all cases and isolated (without any eye or general additional disease) in 67.5% of cases. CONCLUSION: Visual impairment is common and becomes even more severe with aging. Patients should be screened to enable them to benefit from management focusing on both appropriate treatment and genetic counseling.

Central corneal thickness and intraocular pressure in the Cameroonian nonglaucomatous population.

AIM: We performed a prospective, analytical study from 01 January to 31 March 2009 in the Ophthalmology Unit of the Gyneco-Obstetric and Pediatric Hospital of Yaounde, aiming to determine the profile of central corneal thickness (CCT) in the Cameroonian nonglaucomatous black population and its relationship with intraocular pressure (IOP). RESULTS AND DISCUSSION: Four hundred and eighty-five patients (970 eyes) meeting our inclusion criteria were selected for this study. The average CCT was 529.29 +/- 35.9 mum in the right eye (95% confidence interval [CI]: 526.09-532.49), 528.19 +/- 35.9 mum in the left eye (95% CI: 524.99-531.40) and 528.74 +/- 35.89 mum in both eyes (95% CI: 526.48-531.00), range 440 to 670 mum. The average IOP was 13.01 +/- 2.97 mmHg in both eyes (95% CI: 12.82-13.19). A rise in CCT by 100 mum was followed by an increase in IOP of about 2.8 mmHg (95% CI: 2.3-3.6) for both eyes taken together. Linear regression analysis showed that corneal thickness was negatively correlated with age and IOP was positively related with age. CONCLUSION: CCT in the Cameroonian nonglaucomatous black population was found to be lower compared with CCT values in Caucasian and Asian populations. On the basis of reference values ranging between 527 and 560 mum, an adjustment of IOP values by a correction factor is required for many Cameroonian patients. This will improve the diagnosis and follow-up of glaucoma by helping to detect true ocular hypertension.

Cerebral and ocular congenital toxoplasmosis complicated by West syndrome.

We report a case of a child who presented cerebral and ocular congenital toxoplasmosis associated with West syndrome. He was seen and followed-up in the in patients pediatric and ophthalmologic units at the Gyneco-Obstetric and Pediatric Hospital of Yaoundé in Cameroon between July 2008 and February 2010.

[Bilateral blindness and visual impairment in children aged 0-5 years in the women's and children's hospital of Yaounde]. / Cécité et malvoyance bilatérales de l'enfant de 0 à 5 ans à l'hôpital gynéco-obstétrique et pédiatrique de Yaoundé.

A retrospective study covering the period from March 2002 to December 2008 at the Yaounde Women's and Children's Hospital sought to identify the causes of blindness and severe visual impairment in children younger than 5 years old. Of the 55 cases recorded (prevalence: 2.4%), 33 patients were boys and 22 girls. Total blindness were found among 69% of the group, while 31% had severe visually impairment. The most frequent anatomical sites of the disease leading to blindness and severe visual impairment were the lens (27.3%), the visual cortex (25.5%) and the retina (14.5 %). As the initial prognosis is severe, close collaboration between all those responsible for these children must be set up to enable early specialised management and education.

[Eye disease in children aged 6 to 15 years: a hospital-based study in Yaounde]. / La pathologie oculaire de l'enfant âgé de 6 à 15 ans: étude hospitalière à Yaoundé.

UNLABELLED: This prospective study was conducted in the ophthalmology department of the Gynaeco-Obstetric and Paediatric Hospital in Yaoundé and included 422 children recruited from January to April 2008. The aim was to identify the eye diseases seen frequently seen in school-aged children from 6 to 15 years and examine their epidemiological characteristics. RESULTS AND DISCUSSION: The study group included 201 boys and 221 girls, with a mean age of 10,3 +/- 3.2 years. The most frequent disease was ametropia (refractive errors, 43.1%), including hyperopia, which had a prevalence of 23.7% Conjunctival disorders came next, accounting for 33%, more than half due to tropical endemic limbo conjunctivitis (17.8%). Binocular blindness affected 0.9% (n = 4), and low vision 0.7% (n = 3). CONCLUSION: This study, the first in its kind for the age group of 6-15 years in a developing country, allowed us to identify refractive errors as the principal complaint in consultations and led us to propose a reinforcement of screening in schools.

Unilateral childhood blindness: a hospital-based study in Yaoundé, Cameroon.

INTRODUCTION: We performed an analytic and prospective study over a period of 12 months from January 2nd to December 31st, 2008, at the Gynaeco-Obstetric and Paediatric Hospital of Yaoundé, Cameroon. Our aim was to determine the prevalence and causes of unilateral blindness in school children aged 6 to 15 years. RESULTS: Among the 1,266 children aged 6 to 15 years who were recruited, 60 presented with unilateral blindness (4.7%): 42 boys (6.96%) and 18 girls (2.71%). The mean age was 10.15 +/- 3.4 years. In patients with unilateral blindness, 65% was due to ocular trauma. DISCUSSION: The hospital-based prevalence of unilateral blindness in children is relatively high and ocular trauma is the leading etiology. CONCLUSION: Unilateral blindness in school children is avoidable and its incidence could be markedly reduced by emphasizing an information strategy and education based on prevention of ocular trauma. Early management of nontraumatic diseases such as infantile glaucoma and some tumors could improve outcome and avoid blindness.

Determinants of retention in care in an antiretroviral therapy (ART) program in urban Cameroon, 2003-2005.

BACKGROUND: Retention in long-term antiretroviral therapy (ART) program remains a major challenge for effective management of HIV infected people in sub-Saharan Africa. Highly Active Antiretroviral Therapy (ART) discontinuation raises concerns about drug resistance and could negate much of the benefit sought by ART programs. METHODS: Based on existing patient records, we assessed determinants of retention in HIV care among HIV patients enrolled in an urban ART at two urban hospitals in Cameroon. Extended Cox regression procedures were used to identify significant predictors of retention in HIV care. RESULTS: Of 455 patients, 314 (69%) were women, median (IQR) age and baseline CD4 cell count were respectively 36 years (30 - 43) and 110 cells/µL (39 - 177). Forty patients (9%) had active tuberculosis (TB) at enrollment. After a median (IQR) follow-up of 18 months (10-18), 346 (75%) were still in care, 8 (2%) were known dead, and 101 (22%) were lost to follow-up (LFU). Severe immunosuppression (CD4 cell count ≤ 50 cells/µL) at baseline (aHR 2.3; 95% CI 1.4 - 3.7) and active tuberculosis upon enrollment (aHR 1.8; 95% CI 1.0 - 3.6) were independent predictors of cohort losses to follow-up within the first 6 months after HAART initiation. CONCLUSION: These data suggest that three-quarter of HIV patients initiated on HAART remained in care and on HAART by 18 months; however, those with compromised immunologic status at treatment initiation, and those co-infected with TB were at increased risk for being lost to follow-up within the first 6 months on treatment.