The Fred Hollows Foundation is a non-profit aid organisation based in Sydney, Australia, which was founded in 1992 by eye surgeon Fred Hollows. The Foundation focuses on treating and preventing blindness and other vision problems. It operates in Australia, South East Asia, East Asia, the Middle East, and Africa, and has restored sight for over two and a half million people.
Introduction Trachoma is caused by the bacterium Chlamydia trachomatis (Ct). The WHO recommends the SAFE strategy for trachoma elimination: Surgery for trichiasis, Antibiotics, Facial cleanliness and Environmental improvement. Multiple rounds of SAFE implementation have proven insufficient to eliminate trachoma in Ethiopia, where over 50% of the global trachoma burden remains. More effective antibiotic treatment schedules and transmission-suppressing approaches are needed. The aim of stronger SAFE is to evaluate the impact of a novel package of interventions to strengthen the A, F and E of SAFE on the prevalence of ocular Ct and trachoma in Oromia, Ethiopia.Methods and analysis 68 clusters were randomised in a 1:1:1:1 ratio to one of (1) standard A/standard F&E (standard SAFE), (2) standard A/enhanced F&E, (3) enhanced A/standard F&E or (4) enhanced A/enhanced F&E (stronger SAFE). Enhanced A includes two height-based doses of oral azithromycin (equivalent to 20 mg/kg) given as single doses 2 weeks apart, as mass drug administration, annually. Enhanced F&E includes fly control measures (permethrin-treated headwear and odour-baited traps) and face-washing hygiene behaviour change implemented at household level in selected communities. The interventions will be implemented and reinforced over 3 years.The primary outcome is the prevalence of ocular Ct by quantitative PCR in children aged 1–9 years at 36 months. A key secondary outcome is the prevalence of active (inflammatory) trachoma in the same children, assessed by validated trachoma graders and conjunctival photography. Laboratory technicians and photo-graders are masked to treatment allocation. Other important secondary analyses include process evaluations, assessment of behaviour change, fly indicators, adherence and coverage of interventions and a cost analysis.Ethics and dissemination Study protocols have been approved by the National Research Ethics Review Committee of the Ethiopian Ministry of Science and Higher Education and the London School of Hygiene & Tropical Medicine Ethics Committee. An independent data safety and monitoring board oversees the trial. Results will be disseminated through peer-reviewed publications, presentations and reports.Trial registration number ISRCTN40760473.
Introduction:Women, older people and rural residents in low-middle-income settings are mainly impacted by the economic and psychosocial consequences of preventable blindness from undiagnosed and untreated cataracts diabetic retinopathy. Methods:This review of PubMed 2002-2023 and the grey literature aimed to identify strategies effective in reducing access inequities to eye health screening and treatment for the above vulnerable groups. Results:Thirty-nine publications from 16 countries were included. Fifteen focused on cataract, 17 on diabetic retinopathy, and seven on general ophthalmology. This article focuses on the twenty-four studies of moderate or high quality. Rural residents were more likely to benefit (16 studies) while direct effectiveness among women were reported in seven studies. Only three studies reported actual benefits for older people. Outreach services and teleophthalmology were effective interventions increasing screening attendance and referral rates for women and rural residents. Health financing to enhance cataract surgery acceptance and actual surgical rates reported effectiveness for rural residents but showed only modest improvements. Digital technology improved overall appointment uptake and referral adherence for rural residents but not significantly for women. Teleophthalmology was successful in building local capacity for accurate diagnosis but its impact on referral compliance was not demonstrated. Limited evidence was found for the effectiveness of health education alone to boost screening attendance for either subgroup. Discussion:The evidence for effectiveness in reducing inequities is not always direct, uses mixed outcomes, and had heterogenous designs. Yet, the results of the higher quality publications in this review indicate modest improvements worth pursuing further. Systematic Review Registration:https://osf.io/yr7tg/files/osfstorage?view_only=968ba9e8c910470ca227dcdb0da3cda8.
BACKGROUND:We aimed to determine the household distribution and viability of Chlamydia trachomatis (Ct) from the eyes, face, and hands during the initial two visits of a year-long fortnightly cohort study in geographically defined adjacent households. METHODS/FINDINGS:We enrolled 298 individuals from 68 neighbouring households in Shashemene Woreda, Oromia, Ethiopia. All individuals above 2 years of age residing in these households were examined for signs of trachoma. Swab samples were taken from the conjunctiva, faces, and hands and analysed for the presence and viability of Ct. Ct viability was determined using reverse transcription (RT) PCR. At the initial visit, out of 298 individuals, 133 (44.5%) were children aged 2-9 years. Among these children, 27/133 (20.3%) had trachomatous inflammation-follicular (TF), while 8/133 (6.0%) had trachomatous inflammation-intense (TI). Ct (omcB or pORF2) was detected in 16/133 (12.0%) eye swabs, 14/105 (13.5%) face swabs, and 11/105 (10.5%) hand swabs from children aged 2-9 years. Among these children at visit one, 12/14 (85.7%) with Ct on faces and 9/11 (81.8%) with Ct on hands also had detectable ocular Ct. The severity of the disease worsened from the first visit to the second, and no participants showed clearance of the disease within the two-week period. Ct infection was associated with TF (P = 0.002) and TI (P = 0.060). At visit one, among children aged 2-9 years, viable Ct was detected in 12/16 (75.0%) ocular, 6/14 (42.9%) face, and 4/11 (36.4%) hand swab samples. All viable Ct detected on the faces and hands were identified from individuals with viable ocular infections. Among caregivers whose child tested positive for Ct on their hands, 3 caregivers also had Ct on their hands, accounting for 20% (3 out of 15). Additionally, among caregivers whose child tested positive for Ct on their faces, 2 caregivers had Ct on their faces, which accounts for 14.3% (2 out of 14). In two participants, we detected Ct on the hands of ocular-negative children at the initial visit and later detected ocular Ct at the second visit. CONCLUSION/SIGNIFICANCE:Using RT-qPCR assay to detect Ct omp2 mRNA to define viability offers a new, informative perspective of trachoma transmission in this community in Ethiopia. The presence of viable Ct on the faces and hands of individuals living in households with people with current ocular Ct infection supports the hypothesis that hands and faces are important routes for transmission of trachoma. This highlights the importance of targeted interventions to address these sites of Ct carriage to help interrupt transmission.
BackgroundTrachomatous trichiasis (TT) surgery is a key strategy for avoiding blindness and visual impairment from trachoma. We compared alternative WHO-endorsed TT surgery techniques, hypothesizing that in a "real world" study posterior lamellar tarsal rotation (PLTR) would be associated with less postoperative TT (PTT) than bilamellar tarsal rotation (BLTR).MethodsIn an ongoing TT control program in Jimma Zone, Ethiopia, TT surgeons used their preferred procedure (PLTR or BLTR) for upper eyelids with TT. Logistic regression-crude or adjusting for inter-eye correlation and relevant baseline factors (age, number of trichiatic lashes, epilation, entropion severity, and upper palpebral conjunctival scarring severity)-was used to compare the one-year cumulative incidence of PTT (any upper eyelid lash touching the globe, evidence of epilation and/or repeat TT surgery).FindingsMost baseline TT severity markers were worse in the PLTR (855 eyes) than the BLTR (678 eyes) group and PLTR surgeons were less experienced than BLTR surgeons. Nevertheless, one-year cumulative PTT incidences were 8.2% (PLTR) and 21.4% (BLTR; adjusted odds ratio = 0.27, 95% confidence interval: 0.19-0.39). Prospectively ascertained postoperative adverse TT surgery outcomes were similar between groups by six months and 12 months postoperatively.InterpretationWhen surgeons applied their preferred surgical technique, PTT occurred less than half as often with PLTR than BLTR. These real-world data confirm a prior trial's primary result, suggesting that using PLTR instead of BLTR reduces PTT incidence to a clinically important degree without increasing adverse outcomes. Another recent trial suggests continued BLTR is appropriate for surgeons already trained in that technique.Trial registrationwww.clinicaltrials.gov, NCT04149210.
BACKGROUND:Cataract is the primary cause of blindness in China and has a low surgery uptake rate where financial factors are crucial determinants. We report updated data on the financial protection of patients with cataract surgery after the integration of urban and rural medical insurance. METHODS:A population-based survey and hospital administrative data were matched to analyze surgical and total out of pocket (OOP) costs and their burden relative to income; the proportion of total surgical costs paid OOP; and the breakdown of total surgical costs. Multivariate regressions, including key interaction terms, identified socio-demographic factors associated with OOP cost and burden. RESULTS:Among 348 cataract patients, the average surgical OOP cost incurred by patients after any reimbursements was RMB 2945 (USD 427) and total OOP costs averaged RMB 3442 (USD 499), accounting for 25.1% of annual household income. Total surgical costs averaged RMB 5,220 (USD 758), with 44.8% paid OOP and the remaining 55.2% covered by insurance. Material expenses made up 41.3% of the total surgical costs. Having supplementary health insurances and being registered as poverty-stricken households significantly reduced OOP expenditure and burden. However, supplementary insurance was associated with a significantly higher financial burden for lower-middle-income households, highlighting the vulnerability of the 'near poor'. CONCLUSIONS:Financial burden relative to income has decreased after the integration of medical insurance. However, challenges for the 'near poor' population remain. Therefore, not only expand coverage but also optimize insurance benefit design are crucial for enhancing financial protection.
