BACKGROUND:The evaluation unit comprising Kaoma, Luampa, and Nkeyema districts, Western Province, Zambia, has persistent active trachoma. In 2023, we sought to compare the evaluation unit-level prevalence of the active trachoma sign, trachomatous inflammation-follicular (TF), to that of conjunctival Chlamydia trachomatis (Ct) infection and anti-Chlamydia trachomatis (Ct) seropositivity. METHODS:We conducted a cluster-sampled cross-sectional survey. In selected households, we examined all consenting residents ≥1 y of age for trachoma. We collected dried blood spots (DBSs) by finger-prick from children ages 1-9-y and conjunctival swabs from the left eyes of children ages 1-5-y. DBSs were tested for antibodies to the C. trachomatis antigen Pgp3 by lateral flow assay. We tested conjunctival swabs for C. trachomatis DNA by GeneXpert polymerase chain reaction (PCR). RESULTS:The TF prevalence in children ages 1-9-y was 9.2%. In children ages 1-5-y, anti-Pgp3 seroprevalence was 1.7% and the seroconversion rate was 0.6 per 100 person-years. The prevalence of conjunctival C. trachomatis DNA in children ages 1-5-y was 0%. CONCLUSIONS:Based on TF prevalence, this population qualified for additional antibiotic mass drug administration rounds, but PCR and serology-more specific indicators of current or recent C. trachomatis infection than TF-confirmed an absence of significant current community C. trachomatis transmission, allowing a transition to surveillance. Adding these indicators is helpful in persistent active trachoma.

BACKGROUND:Trachoma is a public health problem in Zambia. We aimed to estimate the prevalence of trachomatous inflammation-follicular (TF) in 1-9-y-olds and of trachomatous trichiasis (TT) in ≥15-y-olds after the implementation of trachoma elimination interventions to determine if the trachoma elimination thresholds had been achieved: <5% for TF in 1-9-y-olds and <0.2% TT for ≥15-y-olds. METHODS:Two rounds of impact prevalence surveys in two evaluation units (EUs) comprising four districts of Western Province were conducted; the first in 2018, the second in 2023. All individuals aged ≥1 year from 30 households of 24 clusters in each EU were examined for trachoma. Data were captured electronically. RESULTS:In 2018, TF prevalence in 1-9-y-olds was 13.9% in Kalabo/Sikongo and 17.9% in Shang'ombo/Sioma. Following further interventions, TF prevalence among 1-9-y-olds in 2023 was 7.7% and 12.5%, respectively. TT prevalences in ≥15-y-olds were 0.10% and 0.79% in 2018, and 0.4% and 0.2% in 2023, respectively. CONCLUSIONS:These EUs did not attain trachoma elimination thresholds as a public health problem. They fulfilled the WHO definition for persistent trachoma. Therefore, they warrant further investigation, including collection of Chlamydia trachomatis infection data, to inform future programmatic decision-making. Further TT surgical services are also needed.

Background: Trachoma is the leading infectious cause of irreversible blindness globally. Trichiasis is the sight-threatening stage of trachoma and is a result of chronic inflammation in response to repeated ocular infection with Chlamydia trachomatis, which causes corneal ulceration, entropion, trichiasis and blinding corneal opacification. Trichiasis surgery can reduce the risk of blindness, although some studies have suggested that long-term recurrence rates may be high, hence the need for ongoing technical support and monitoring of surgical services. Aim: The study aimed to assess outcomes of the patients undergoing surgery for Trachomatous Trichiasis in Western Province, Zambia Methods: A retrospective multi-health facility-based study was conducted in September 2018 using systematic sampling technique to select patient records. All the selected records were linked to patients who were examined between three-six months post Trabut surgery. Western Province was selected for this study because it was one of the provinces with the highest burden of trachoma. Results: The total number of participants who were selected and assessed was 74 with a mean age of 56 years. A total of 64 (86.5%) participants were female while 10 (13.5%) were males. The majority of the participants 41 (55.4%) had bilateral while 33 (44.6%) had unilateral pre-operative trichiasis. Seventy-three participants (98.6%) had no trichiasis post operatively. The following complications were observed post operatively; eyelid abnormality three eyes (4.1%), eyelid closure defect two eyes (2.7%), granuloma one eye (1.4%) and recurrent trichiasis one eye (1.4%). Conclusion: Trachomatous trichiasis surgical outcomes using Trabut surgical technique acceptable at three to six months follow up.

Purpose Population-based prevalence surveys are essential for decision-making on interventions to achieve trachoma elimination as a public health problem. This paper outlines the methodologies of Tropical Data, which supports work to undertake those surveys.Methods Tropical Data is a consortium of partners that supports health ministries worldwide to conduct globally standardised prevalence surveys that conform to World Health Organization recommendations. Founding principles are health ministry ownership, partnership and collaboration, and quality assurance and quality control at every step of the survey process. Support covers survey planning, survey design, training, electronic data collection and fieldwork, and data management, analysis and dissemination. Methods are adapted to meet local context and needs. Customisations, operational research and integration of other diseases into routine trachoma surveys have also been supported.Results Between 29th February 2016 and 24th April 2023, 3373 trachoma surveys across 50 countries have been supported, resulting in 10,818,502 people being examined for trachoma.Conclusion This health ministry-led, standardised approach, with support from the start to the end of the survey process, has helped all trachoma elimination stakeholders to know where interventions are needed, where interventions can be stopped, and when elimination as a public health problem has been achieved. Flexibility to meet specific country contexts, adaptation to changes in global guidance and adjustments in response to user feedback have facilitated innovation in evidence-based methodologies, and supported health ministries to strive for global disease control targets.

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.

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.

Background Achieving elimination of trachoma as a public health problem in trichiasis-endemic districts requires a systematic approach to trichiasis case finding and outreach. Methods Programme monitoring data from seven countries for 2017-2019 were used to explore the efficiency of different community mobilisation approaches and uptake of trichiasis surgical services. Results Three countries (Ethiopia, Kenya and Mozambique) using broad-based community mobilisation strategies had large numbers of people presenting at outreach but only 2.9% of them had trichiasis, while in four countries (Nigeria, Tanzania, Uganda and Zambia) using house-to-house case finding, 37.5% of outreach attendees had trichiasis. Countries using house-to-house case finding have proportionally more women attending outreach compared with countries using broad-based mobilisation. Among trichiasis cases offered surgery 86% accepted, which was similar for men and women. Conclusions In these settings, house-to-house case finding appears to be a more effective and efficient approach to ensure that trichiasis cases, particularly in women, obtain access to surgical services.

This study aims to determine the association between water, sanitation, and hygiene, and the prevalence of trachoma in Monze district, Zambia. The overall prevalence of trachoma among residents of Monze district is 2.0% disaggregated as 3.4% for 1–9 age group and 1.1% for ≥10 age group. The findings reveal an association between trachoma eye infection and drinking water source from protected well/spring, and piped water. After adjusting for other variables, there was an association of drinking water from a protected well/spring (AOR 8.343, CI 1.126–61.803), piped water (AOR 4.127, CI 1.088–15.648), and piped water for washing (AOR 0.172, 95% CI 0.031–0.944.439). The presence of a hand wash facility was very low at 2.9% while hand washing agents were even lower at 0.41%. The study concludes that children are at a higher risk of trachoma prevalence. Other WASH aspects, such as adequacy of water, might be more important than the presence of potable water. The prevalence of trachoma in Monze is WASH focused.

Purpose: A number of previous administrative-district-level baseline trachoma prevalence estimates in Zambia required verification. We used methodologies and systems for trachoma surveys considered to represent international best practice in order to generate reliable estimates of the prevalence of trachoma. Methods: Between March 2016 and July 2017, we undertook 32 population-based prevalence surveys covering 47 administrative districts. In each of the 32 evaluation units (EUs), we selected 31 households in each of 24 clusters. In selected households, trained, certified graders examined all residents aged 1 year and above for evidence of trachomatous inflammation-follicular (TF) and trichiasis. In eyes that had trichiasis, the presence or absence of trachomatous scarring (TS) was recorded, and the subject was asked about previous trichiasis management recommendations from health workers. Results: Five EUs (encompassing seven administrative districts) had prevalence estimates of trichiasis+TS unknown to the health system in >= 15-year-olds of >= 0.2%, and require public-health-level implementation of trichiasis surgery services. Eleven EUs (encompassing 16 administrative districts) had TF prevalence estimates in 1-9-year-olds of >= 5%. Intervention with the A, F and E components of the SAFE strategy for trachoma elimination is required for nearly 1.5 million people. Conclusion: Trachoma is a public health problem in some parts of Zambia. The Ministry of Health will continue to partner with other stakeholders to implement the multi-sectoral SAFE strategy. Consideration should be given to re-surveying other suspected-endemic administrative districts in which surveys using older methodologies returned TF prevalence estimates >= 5%.

Background The Global Trachoma Mapping Project (GTMP) was implemented with the aim of completing the baseline map of trachoma globally. Over 2.6 million people were examined in 1,546 districts across 29 countries between December 2012 and January 2016. The aim of the analysis was to estimate the unit cost and to identify the key cost drivers of trachoma prevalence surveys conducted as part of GTMP. Methodology and principal findings In-country and global support costs were obtained using GTMP financial records. In-country expenditure was analysed for 1,164 districts across 17 countries. The mean survey cost was $13,113 per district [median: $11,675; IQR = $8,365-$14,618], $17,566 per evaluation unit [median: $15,839; IQR = $10,773-$19,915], $692 per cluster [median: $625; IQR = $452-$847] and $6.0 per person screened [median: $4.9; IQR = $3.7-$7.9]. Survey unit costs varied substantially across settings, and were driven by parameters such as geographic location, demographic characteristics, seasonal effects, and local operational constraints. Analysis by activities showed that fieldwork constituted the largest share of in-country survey costs (74%), followed by training of survey teams (11%). The main drivers of in-country survey costs were personnel (49%) and transportation (44%). Global support expenditure for all surveyed districts amounted to $5.1m, which included grant management, epidemiological support, and data stewardship. Conclusion This study provides the most extensive analysis of the cost of conducting trachoma prevalence surveys to date. The findings can aid planning and budgeting for future trachoma surveys required to measure the impact of trachoma elimination activities. Furthermore, the results of this study can also be used as a cost basis for other disease mapping programmes, where disease or context-specific survey cost data are not available.