Francis I. Proctor, MD and his wife Elizabeth C. Proctor: Their lives and legacy.

The Francis I. Proctor Foundation for Research in Ophthalmology is internationally recognized for its research in the fields of ocular inflammatory and infectious diseases. Although the name of one of its founders, Francis I. Proctor, MD (1864-1936) is memorialized, the legacy of his wife, Elizabeth C. Proctor (1882-1975) is not as well known. They were both full partners in this endeavor. Francis, a successful and wealthy ophthalmologist, retired to Santa Fe, New Mexico. After their marriage, they became interested in the problem of blinding trachoma, then an endemic problem on the Native American Indian reservations. The couple selected Phillips Thygeson, MD (1903-2002), a young ophthalmologist with an interest in infectious diseases, as their lead investigator. Using their own funds, the Proctors paid for Thygeson and themselves to study trachoma in Egypt, and then establish a trachoma research laboratory in Arizona where the causative agent of trachoma was identified. Not only did the Proctors fund these studies, they also studied bacteriology so they could help in the laboratory themselves. After Francis' death, Elizabeth endowed the Foundation in 1947 and continued to support it. She also established the Proctor Medal for The Association for Research in Vision and Ophthalmology.

Unimproved water sources and open defecation are associated with active trachoma in children in internally displaced persons camps in the Darfur States of Sudan.

PURPOSE: To estimate the proportion of children with trachomatous inflammation-follicular (TF) and adults with trachomatous trichiasis (TT) in internally displaced persons (IDP) camps in the Darfur States of Sudan and to evaluate associated risk factors. METHODS: IDP camps were identified from government census data. We conducted a subanalysis of data collected in these camps during 2014-2015 as part of surveys covering 37 districts of the Darfur States within the Global Trachoma Mapping Project. A random-effects hierarchical model was used to evaluate factors associated with TF in children or TT in adults. RESULTS: Thirty-six IDP camps were represented in the survey data, in which 1926 children aged 1-9 y were examined, of whom 38 (8%) had TF. Poor sanitation, younger age and living in a household that purchased water from a vendor were associated with TF in children aged 1-9 y. Of 2139 individuals examined aged ≥15 y, 16 (0.7%) had TT. TT was strongly independently associated with being older and living alone. CONCLUSION: Trachoma is found at low levels in these camps, but still at levels where intervention is needed. Disease elimination in conflict-related settings presents a unique challenge for the trachoma community, and may require an innovative approach. Understanding how best to undertake trachoma elimination interventions in these areas should be prioritized.

The Epidemiology of Trachoma in Mozambique: Results of 96 Population-Based Prevalence Surveys.

PURPOSE: Surveys are needed to guide trachoma control efforts in Mozambique, with WHO guidelines for intervention based on the prevalence of trachomatous inflammation-follicular (TF) in children aged 1-9 years and the prevalence of trichiasis in adults aged 15 years and above. We conducted surveys to complete the map of trachoma prevalence in Mozambique. METHODS: Between July 2012 and May 2015, we carried out cross-sectional surveys in 96 evaluation units (EUs) covering 137 districts. RESULTS: A total of 269,217 individuals were enumerated and 249,318 people were examined using the WHO simplified trachoma grading system. Overall, 102,641 children aged 1-9 years, and 122,689 individuals aged 15 years and above were examined. The prevalence of TF in children aged 1-9 years was ≥10% in 12 EUs, composed of 20 districts, covering an estimated total population of 2,455,852. These districts require mass distribution of azithromycin for at least 3 years before re-survey. The TF prevalence in children was 5.0-9.9% in 17 EUs (28 districts, total population 3,753,039). 22 EUs (34 districts) had trichiasis prevalences ≥0.2% in adults 15 years and above, and will require public health action to provide surgical services addressing the backlog of trichiasis. Younger age, more children resident in the household, and living in a household that had an unimproved latrine or no latrine facility, were independently associated with an increased odds of TF in children aged 1-9 years. CONCLUSIONS: Trachoma represents a significant public health problem in many areas of Mozambique.

Prevalence of Trachoma and Access to Water and Sanitation in Benue State, Nigeria: Results of 23 Population-Based Prevalence Surveys.

PURPOSE: We sought to determine the prevalence of trachoma in each local government area (LGA) of Benue State, Nigeria. METHODS: Two-stage cluster sampling was used to conduct a series of 23 population-based prevalence surveys. LGAs were the evaluation units surveyed. In each LGA, 25 households were selected in each of 25 clusters, and individuals aged 1 year and above resident in those households were invited to be examined for trachoma. Data on access to water and sanitation were also collected at household level. RESULTS: A total of 91,888 people were examined from among 93,636 registered residents across the 23 LGAs. The LGA-level prevalence of trachomatous inflammation-follicular (TF) in 1-9 year olds ranged from 0.3% to 5.3%. Two LGAs had TF prevalences of 5.0-9.9%. The LGA-level prevalence of trichiasis in ≥15-year-olds ranged from 0.0% to 0.35%. Access to improved drinking water sources ranged from 0% in Gwer West to 99% in Tarka, while access to improved sanitation ranged from 1% in Gwer West to 92% in Oturkpo. CONCLUSION: There is a need for public health-level interventions against trachoma in three LGAs of Benue State.

Predictors of Trachomatous Trichiasis Surgery Outcome.

PURPOSE: Unfavorable outcomes after trachomatous trichiasis (TT) surgery are undermining the global trachoma elimination effort. This analysis investigates predictors of postoperative TT (PTT), eyelid contour abnormalities (ECAs), and granuloma in the 2 most common TT surgery procedures: posterior lamellar tarsal rotation (PLTR) and bilamellar tarsal rotation (BLTR). DESIGN: Secondary data analysis from a randomized, controlled, single-masked clinical trial. PARTICIPANTS: A total of 1000 patients with TT, with lashes touching the eye or evidence of epilation, in association with tarsal conjunctival scarring. METHODS: Participants were randomly allocated and received BLTR (n = 501) or PLTR (n = 499) surgery. Disease severity at baseline, surgical incisions, sutures, and corrections were graded during and immediately after surgery. Participants were examined at 6 and 12 months by assessors masked to allocation. MAIN OUTCOME MEASURES: Predictors of PTT, ECA, and granuloma. RESULTS: Data were available for 992 (99.2%) trial participants (496 in each arm). There was strong evidence that performing more peripheral dissection with scissors in PLTR (odd ratio [OR], 0.70; 95% confidence interval [CI], 0.54-0.91; P = 0.008) and BLTR (OR, 0.83; 95% CI, 0.72-0.96; P = 0.01) independently protected against PTT. Baseline major trichiasis and mixed location lashes and immediate postoperative central undercorrection independently predicted PTT in both surgical procedures. Peripheral lashes in PLTR (OR, 5.91; 95% CI, 1.48-23.5; P = 0.01) and external central incision height ≥4 mm in BLTR (OR, 2.89; 95% CI, 1.55-5.41; P = 0.001) were independently associated with PTT. Suture interval asymmetry of >2 mm (OR, 3.18; 95% CI, 1.31-7.70; P = 0.01) in PLTR and baseline conjunctival scarring in BLTR (OR, 1.72; 95% CI, 1.06-2.81; P = 0.03) were independently associated with ECA. Older age was independently associated with ECA in both PLTR (P value for trend < 0.0001) and BLTR (P value for trend = 0.03). There was substantial intersurgeon variability in ECA rates for both PLTR (range, 19.0%-36.2%) and BLTR (range, 6.1%-28.7%) procedures. In PLTR surgery, irregular posterior lamellar incision at the center of the eyelid (OR, 6.72; 95% CI, 1.55-29.04; P = 0.01) and ECA (OR, 3.08; 95% CI, 1.37-6.94; P = 0.007) resulted in granuloma formation. CONCLUSIONS: Poor postoperative outcomes in TT surgery were associated with inadequate peripheral dissection, irregular incision, asymmetric suture position and tension, inadequate correction, and lash location. Addressing these will improve TT surgical outcomes.

Prevalence of and Risk Factors for Trachoma in Southern Nations, Nationalities, and Peoples' Region, Ethiopia: Results of 40 Population-Based Prevalence Surveys Carried Out with the Global Trachoma Mapping Project.

PURPOSE: We sought to estimate the prevalence of trachoma at sufficiently fine resolution to allow elimination interventions to begin, where required, in the Southern Nations, Nationalities, and Peoples' Region (SNNPR) of Ethiopia. METHODS: We carried out cross-sectional population-based surveys in 14 rural zones. A 2-stage cluster randomized sampling technique was used. A total of 40 evaluation units (EUs) covering 110 districts ("woredas") were surveyed from February 2013 to May 2014 as part of the Global Trachoma Mapping Project (GTMP), using the standardized GTMP training package and methodology. RESULTS: A total of 30,187 households were visited in 1047 kebeles (clusters). A total of 131,926 people were enumerated, with 121,397 (92.0%) consenting to examination. Of these, 65,903 (54.3%) were female. In 38 EUs (108 woredas), TF prevalence was above the 10% threshold at which the World Health Organization recommends mass drug administration with azithromycin annually for at least 3 years. The region-level age- and sex-adjusted trichiasis prevalence was 1.5%, with the highest prevalence of 6.1% found in Cheha woreda in Gurage zone. The region-level age-adjusted TF prevalence was 25.9%. The highest TF prevalence found was 48.5% in Amaro and Burji woredas. In children aged 1-9 years, TF was associated with being a younger child, living at an altitude <2500m, living in an area where the annual mean temperature was >15°C, and the use of open defecation by household members. CONCLUSION: Active trachoma and trichiasis are significant public health problems in SNNPR, requiring full implementation of the SAFE strategy (surgery, antibiotics, facial cleanliness, and environmental improvement).

Rural children active trachoma risk factors and their interactions.

INTRODUCTION: Trachoma is a serious public health problem in rural Ethiopia. The aim of this investigation was to provide in-depth statistical analysis of the risk factors associated with active trachoma among children of age 1-9 years of Kedida Gamela district, in Ethiopia. METHODS: A community based cross-sectional survey of trachoma was conducted in six selected rural kebeles of Kedida Gamela district, in Ethiopia from June 10-25, 2014. A total of 377 children (ages 1-9 years) were included in the study using two stage cluster sampling. All children were examined for trachoma by nurse data collectors supervised by ophthalmic supervisors using the WHO simplified clinical grading system. Ordinal survey logistic regression model was used to identify risk factors. Data analysis was done using SAS version 9.3. RESULTS: The best fit proportional odds model was identified to be the main effects and two-way and three-way interactios. Keeping cattle in the house was found to have a protective effect (OR=0.138, p-value=0.0003). The household wealth will have a more protective effect if the child attends school. Washing face with soap and water once a day has equivalent protective effect as washing face three-or-more times a day with water only. CONCLUSION: The 2-way and 3-way significant interactions effects unfolded some of the controversies derived from similar studies on trachoma risk factors. The findings would suggest integrated effort to address two or three factors simultaneously is more fruitful than any novel intervention targeted to address a single risk factor.

Exposure to an Indoor Cooking Fire and Risk of Trachoma in Children of Kongwa, Tanzania.

BACKGROUND: Elimination of blinding trachoma by 2020 can only be achieved if affected areas have effective control programs in place before the target date. Identifying risk factors for active disease that are amenable to intervention is important to successfully design such programs. Previous studies have linked sleeping by a cooking fire to trachoma in children, but not fully explored the mechanism and risks. We propose to determine the risk for active trachoma in children with exposure to cooking fires by severity of trachoma, adjusting for other known risk factors. METHODS: Complete census of 52 communities in Kongwa, Tanzania, was conducted to collect basic household characteristics and demographic information on each family member. Information on exposure to indoor cooking fires while the mother was cooking and while sleeping for each child was collected. 6656 randomly selected children ages 1-9 yrs were invited to a survey where both eyelids were graded for follicular (TF) and intense trachoma (TI) using the WHO simplified grading scheme. Ocular swab were taken to assess the presence of Chlamydia trachomatis. FINDINGS: 5240 (79%) of the invited children participated in the study. Overall prevalence for trachoma was 6·1%. Odds for trachoma and increased severity were higher in children sleeping without ventilation and a cooking fire in their room (TF OR = 1·81, 1·00-3·27 and TI OR 4·06, 1·96-8·42). Children with TF or TI who were exposed were more likely to have infection than children with TF or TI who were not exposed. There was no increased risk with exposure to a cooking fire while the mother was cooking. CONCLUSIONS: In addition to known risk factors for trachoma, sleeping by an indoor cooking fire in a room without ventilation was associated with active trachoma and appears to substantially increase the risk of intense inflammation.

Situação epidemiológica do tracoma entre estudantes da rede pública de municípios do Piauí / Epidemiological situation of trachoma among students from public Piaui municipalities

O tracoma é uma afecção inflamatória ocular, bilateral e recidivante causada pela Chlamydia trachomatis. Casos de cegueira por esta doença estão relacionados a precárias condições de vida, afetando as pessoas de baixa renda que vivem preferencialmente em zonas rurais. Objetivos: Descrever os casos de tracoma diagnosticados em inquéritos epidemiológicos em escolares do Piauí no período de 2007 a 2013. Métodos: estudo descritivo realizado por meio de dados secundários de acesso restrito dos casos de Tracoma diagnosticados em inquéritos epidemiológicos em escolares no estado do Piauí de 2007 até 2013. Resultados: o percentual (por cento) de tracoma no Piauí foi 2,6 por cento; e 50,4 por cento dos casos eram do sexo feminino. Já faixa etária mais acometida foi entre 1 e 9 anos de idade (89,3 por cento). Em relação à zona de moradia 68,3 por cento residiam em zona rural. Houve percentual maior das formas mais brandas da doença, o tracoma inflamatório folicular (71,21 por cento), seguido da forma tracoma inflamatório intenso (27,70 por cento). Não foram encontrados casos da forma mais grave da doença. Conclusão: a situação de percentual de tracoma em escolares no Piauí foi das formas brandas que são tracoma inflamatório folicular e tracoma inflamatório intenso; adoção de medidas de prevenção e controle capacitação profissionais da área de saúde para detecção e realização de outros estudos em regiões semelhantes aos do inquérito e que ainda não foram avaliadas no estado em busca de novos e possíveis focos da doença...

Trachoma is an eye inflammatory disease, bilateral and recurrent caused by Chlamydia trachomatis. Cases of blindness from this disease are related to poor living conditions, affecting low-income people who live preferably in rural areas. Objectives: To describe the cases of trachoma diagnosed in epidemiological surveys in Piauí the school from 2007 to 2013. Methods: A descriptive study using secondary data restricted cases of trachoma diagnosed in epidemiological surveys with schoolchildren in Piauí State 2007 to 2013. Results: the percentage (percent) of trachoma in Piaui was 2.6 percent; and 50.4 percent of cases were female. Already most affected age group was between 1 and 9 years old (89.3 percent). In relation to housing zone 68,3 percent lived in rural areas. There was a higher percentage of the milder forms of the disease, follicular inflammatory trachoma (71,21 percent), followed by the form intense inflammatory trachoma (27,70 percent). There were no cases of the more severe form of the disease. Conclusion: the situation of trachoma percentage in school in Piauí was the milder forms that are follicular inflammatory trachoma and intense inflammatory trachoma; adoption professionals prevention and control capacity building measures of health to detect and carry out further studies in areas similar to the investigation and not yet evaluated in the state in search of new and potential outbreaks of disease...

Follicular trachoma and trichiasis prevalence in an urban community in The Gambia, West Africa: is there a need to include urban areas in national trachoma surveillance?

OBJECTIVES: Urban areas are traditionally excluded from trachoma surveillance activities, but due to rapid expansion and population growth, the urban area of Brikama in The Gambia may be developing social problems that are known risk factors for trachoma. It is also a destination for many migrants who may be introducing active trachoma into the area. This study aimed to determine the prevalence and risk factors for follicular trachoma and trichiasis in Brikama. METHODS: A community-based cross-sectional prevalence survey including 27 randomly selected households in 12 randomly selected enumeration areas (EAs) of Brikama. Selected households were offered eye examinations, and the severity of trachoma was graded according to WHO's simplified grading system. Risk factor data were collected from each household via a questionnaire. RESULTS: The overall prevalence of trachomatous inflammation-follicular (TF) in children aged 1-9 years was 3.8% (95% CI 2.5-5.6), and the overall prevalence of trichiasis in adults aged ≥15 years was 0.46% (95% CI 0.17-1.14). EA prevalence of TF varied from 0% to 8.4%. The major risk factors for TF were dirty faces (P < 0.01, OR = 9.23, 95% CI 1.97-43.23), nasal discharge (P = 0.039, OR = 5.11, 95% CI 1.08-24.10) and residency in Brikama for <1 year (P = 0.047, OR = 7.78, 95% CI 1.03-59.03). CONCLUSIONS: Follicular trachoma can be considered to have been eliminated as a public health problem in Brikama according to WHO criteria. However, as the prevalence in some EAs is >5%, it may be prudent to include Brikama in surveillance programmes. Trichiasis remains a public health problem (>0.1%), and active case finding needs to be undertaken.

Rapid trachoma assessment in Kersa District, Southwest Ethiopia.

BACKGROUND: Trachoma is the leading cause of infectious blindness worldwide. Though trachoma can be treated with antibiotics (active trachoma) or surgery (trachomatous trichiasis), it is still endemic in most parts of Ethiopia. Despite the prevalence of this infectious disease in different parts of the country, district level data is lacking. This study was thus conducted to assess the prevalence estimate of trachoma and its risk factors in Kersa District, Southwest Ethiopia. METHODS: A community based cross sectional Rapid Assessment of Trachoma was conducted using a WHO guideline. Six sub-districts were selected from Kersa District based on primary high risk assessment and from each sub-district; 21-27 households were randomly selected. Active trachoma for children aged 1-9 years, trachomatous trichiasis for people above 15 years old and environmental risk factors for trachoma were assessed. Data were analyzed using SPSS version 16. RESULTS: The overall prevalence estimate of active trachoma was 25.2% (95% CI: 20.7-30.4%). Forty three percent of children had unclean faces, 11.5% of households had water source at more than half hour walking distance, 18.2% did not have functional latrine, and 95.3% of the households had solid waste disposal within a distance of 20 meters. Households with environmental risk factors were at an increased risk to active trachoma, but the association was not statistically significant (p>0.05). The prevalence estimate of trachomatous trichiasis inclusive of "trachoma suspects" was 4.5%. CONCLUSION: Trachoma is endemic in Kersa District with active trachoma being a public health problem in the studied sub-districts. Hence, SAFE strategy should be implemented.

Trachomatous trichiasis clamp vs standard bilamellar tarsal rotation instrumentation for trichiasis surgery: results of a randomized clinical trial.

OBJECTIVE: To determine whether a new surgical clamp reduces unfavorable postoperative outcomes. METHODS: Patients with trachomatous trichiasis (TT) were randomized to surgery with standard bilamellar tarsal rotation (BLTR) instrumentation or the TT clamp and were followed up for 2 years. MAIN OUTCOME MEASURES: Postoperative TT, pyogenic granuloma formation, and eyelid contour abnormalities, combined and individually. RESULTS: A total of 1917 participants who had surgery (3345 eyes) were enrolled. Rates of at least 1 unfavorable outcome were similar for the participants who underwent surgery with the TT clamp and those who underwent surgery with standard BLTR (60.9% vs 63.0%, respectively; adjusted odds ratio [AOR] = 0.88; 95% CI, 0.66-1.18). Granuloma was less common in the TT clamp arm than in the standard BLTR arm (16.8% vs 22.4%, respectively; AOR = 0.67; 95% CI, 0.46-0.97). There was a trend toward increased postoperative TT in the TT clamp arm compared with the standard BLTR arm (43.2% vs 36.6%, respectively; AOR = 1.36; 95% CI, 0.96-1.93). The TT clamp decreased the risk of mild eyelid contour abnormalities compared with standard BLTR (9.1% vs 13.3%, respectively; AOR = 0.64; 95% CI, 0.42-0.97) and showed a trend for a decrease in moderate abnormalities (5.3% vs 7.8%, respectively; AOR = 0.63; 95% CI, 0.39-1.01). CONCLUSIONS: Overall, rates of unfavorable outcomes were similar between groups. Although our results are similar to other programmatic settings, such high rates of unfavorable outcomes are unacceptable; future research is needed to identify ways to improve TT surgery outcomes. APPLICATION TO CLINICAL PRACTICE: A new clamp for TT surgery appears to offer protection against granuloma formation and some eyelid contour abnormalities, but it does not reduce postoperative TT. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00886015.

Tracoma: aspectos epidemiológicos no Brasil, 2009-2010 e perspectivas de controle / Trachoma: epidemiological aspects in Brazil, 2009-2010 and prospects for control

O tracoma é uma afecção inflamatória ocular crônica (ceratoconjuntivite crônica recidivante) que tem como agente etiológico a bactéria Chlamydia trachomatis. É reconhecido como importante problema de saúde pública, por ser esta a principal causa de cegueira evitável. Afeta 41 milhões de pessoas em todo o mundo das quais 1,3 milhões são cegas devido ao tracoma. A Organização Mundial de Saúde – OMS considera o tracoma endêmico em regiões subdesenvolvidas da África, Oriente Médio, Subcontinente Indiano, Sudeste da Ásia e nas Américas Central e Sul. No Brasil a prevalência conhecida no último inquérito nacional realizado no período de 2002 a 2008 detectou municípios com alta prevalência em todas as regiões do país e um coeficiente médio nacional de 5,1% de tracoma ativo. Este estudo tem por objetivo descrever o sistema de vigilância epidemiológica do tracoma no Brasil e os aspectos epidemiológicos da doença com base nas notificações no Sinan nos anos de 2009e 2010 e nos dados repassados diretamente a coordenação do agravo na SVS. Trata-se de um sistema de busca ativa de casos sob a responsabilidade dos estados e municípios que utiliza dados do último inquérito como base para identificação de foco. A abrangência do inquérito foi de 30% do total de municípios do país o que faz com que a maior parte dos municípios desconheça sua situação em relação ao tracoma. Nos dois anos analisados pouco mais de 300 municípios realizaram atividade de busca de casos, com destaque para os estados do Ceará, São Paulo, Bahia e Tocantins. Neste período foram examinadas 573.576 pessoas com 25.042 casos, o que corresponde a 4,4% de prevalência média. Com 80% dos inquéritos realizados em escolas da zona urbana, a maioria dos casos identificados foi de TF em crianças menores de 10 anos do sexo feminino. Os resultados demonstram que a doença permanece na população brasileira e que grande parte dos municípios não realiza o monitoramento de situação para a devida adoção de medidas preventivas. É fundamental estabelecer uma rotina de retroalimentação desses dados de forma ampla, de modo a impulsionar a utilização do Sinan como ferramenta oficial de notificação e implantação das ações de vigilância e controle do tracoma na rotina dos serviços de saúde com maior envolvimento dos gestores.

Trachoma is an inflammatory chronic eye disease (chronic relapsing keratitis) which has as etiological agent the bacteria Chlamydia trachomatis. Is recognized as an important public health problem that is the leading cause of preventable blindness. Affects 41 million people worldwide of which 1.3 million are blind because of trachoma. The World Health Organization – WHO considers the trachoma endemic in underdeveloped regions of Africa, the Middle East, the Indian subcontinent, Southeast Asia and Central and South America. In Brazil the prevalence known in the last national survey conducted from 2002 to 2008 found municipalities with high prevalence in all regions of the country and a national average of 5.1 coefficient of active trachoma. This study aims to describe the epidemiological surveillance system of trachoma in Brazil and epidemiological aspects of the disease on the basis of the notifications at Sinan in the years 2009 and 2010 and in data transferred directly coordinating the further SVS. It is a system of active search for cases under the responsibility of the States and municipalities that uses data from the latest survey as the basis for identification of focus. The scope of the investigation was of 30% of the total municipalities in the country which causes most municipalities don't know their situation in relation to trachoma. In the two years was considered little more than 300 municipalities carried out case search activity, especially for the States of Ceará, Bahia, São Paulo, and Tocantins. In this period were examined 573,576 people with 25,042 cases, which correspond to the average prevalence of 4.4%. With 80% of surveys conducted in schools in the urban area, most cases TF was identified in children younger than 10 years female. The results show that the disease remains in the Brazilian population and that much of the municipalities does not perform monitoring situation due to the adoption of preventive measures. It is essential to establish a routine of feedback of the data broadly, so as to boost the use of Sinan as official notification and deployment tool for surveillance and control of trachoma in the routine of health services with greater involvement of managers.

Active trachoma and associated risk factors among children in Baso Liben District of East Gojjam, Ethiopia.

BACKGROUND: Trachoma is the leading cause of preventable blindness worldwide. It is common in areas where the people are socio-economically deprived. The aim of this study was to assess active trachoma and associated risk factors among children 1-9 years in East Gojjam. METHODS: Community-based cross-sectional study was conducted in Baso Liben District from February to April 2012. A two-stage random cluster-sampling technique was employed and all children 1-9 years old from each household were clinically assessed for trachoma based on simplified WHO 1983 classification. Data were collected by using semi-structured interview, pre-tested questionnaire and observation. The data were entered and analyzed using SPSS version 16 statistical package. RESULTS: From a total of 792 children screened for trachoma (of which 50.6% were girls), the overall prevalence of active trachoma was 24.1% consisting of only 17.2% [95% CI: 14.8, 20.1] TF and 6.8% TI. There were variations among children living in low land (29.3%) and in medium land (21.4%). In multivariate analysis, low monthly income (AOR = adjusted odds ratio) 2.98; 95% CI (confidence interval): 1.85-7.85), illiterate family (AOR = 5.18; 95% CI: 2.92-9.17); unclean face (AOR = 18.68; 95% CI: 1.98-175.55); access to water source (AOR = 2.01; 95% CI: 1.27-3.15); less than 20 liters of water use (AOR = 4.88; 95% CI: 1.51-15.78); not using soap for face washing (AOR = 5.84; 95% CI: 1.98-17.19); not using latrine frequently (AOR = 1.75; 95% CI: 0.01-0.42); density of flies (AOR = 3.77; 95% CI: 2.26-6.29); less knowledgeable family (AOR = 3.91; 95% CI: 2.40-6.38) and average monthly income (AOR = 2.98; 95% CI: 1.85-7.85) were found independently associated with trachoma. CONCLUSION: Active trachoma is a major public problem among 1-9 years children and significantly associated with a number of risky factors. Improvement in awareness of facial hygiene, environmental conditions, mass antibiotic distribution and health education on trachoma transmission and prevention should be strengthened in the District.

[Infections with Chlamydia trachomatis]. / Infektionen mit Chlamydia trachomatis.

The gram-negative obligate intracellular bacterium Chlamydia trachomatis is the pathogen that is most often transmitted through sexual contact. C. trachomatis is responsible for a wide range of different diseases. Strains of serovars D to K primarily cause urogenital infections, which are often asymptomatic, but can also lead to uncomplicated and complicated genital diseases. Pelvic inflammatory diseases attributed to ascending genital infections can result in ectopic pregnancies and infertility in women. After perinatal transmission, infections in the newborn can also occur. Strains of serovars L1, L2 and L3 cause lymphogranuloma venereum, a common sexually transmitted disease in many tropical and subtropical regions. The illness is associated with various skin lesions and systemic symptoms such as fever and headache. Unlike other serovars, strains of serovar A, B and C are transmitted primarily by infectious eye discharge. They cause a chronic eye disease called trachoma that occurs under poor hygienic conditions. Infections with C. trachomatis should be treated with antibacterial drugs reaching high intracellular concentrations. The choice of antibiotics and duration of treatment depend on the indication. In general, intracellular acting agents such as doxycycline, macrolides like azithromycin and erythromycin and certain quinolones (i.e. levofloxacin and ofloxacin) are applied for specific therapy of C. trachomatis infections. During pregnancy, application of macrolides or aminopenicillins has been recommended for most indications. Because of the serious potential consequences of urogenital C. trachomatis infection in women, many industrialized countries offer a C. trachomatis screening. For the elimination of trachoma, which is envisaged by the World Health Organization for the year 2020, the so-called SAFE strategy is used. This strategy includes therapeutic and hygienic measures that may be suitable to eliminate one of the leading causes of blindness worldwide.

Surgery versus epilation for the treatment of minor trichiasis in Ethiopia: a randomised controlled noninferiority trial.

BACKGROUND: Trachomatous trichiasis can cause corneal damage and visual impairment. WHO recommends surgery for all cases. However, in many regions surgical provision is inadequate and patients frequently decline. Self-epilation is common and was associated with comparable outcomes to surgery in nonrandomised studies for minor trichiasis (

Relationship between distance to social gathering facilities and risk of trachoma for households in rural Tanzanian communities.

Few studies have examined the physical isolation of households with trachoma cases. Thus, in this study, we sought to examine the association between household isolation, as measured by distance to social gathering facilities, and risk of trachoma. We hypothesized that households located closer to such facilities would have a decreased risk of trachoma, due to a variety of social, economic, and cultural reasons. To test this hypothesis we conducted a case-control study of 668 households (93 cases, 575 controls) in eight villages in Kongwa District, Tanzania, in 2007. Case households were defined as having a child aged 1-5 years with clinical signs of trachoma. Distance of household's place of residence to three main social gathering facilities - bars/cafés, religious establishments, and commercial/government center - was measured with a portable geographic positioning system. Multiple logistic regression analyses, which controlled for potential confounders and accounted for clustering, demonstrated increased risk of trachoma with increasing distance to social gathering facilities. Compared with distances of ≤700 m, odds of trachoma were approximately two-fold higher for households living >1400 m from bars/cafés and from religious establishments, suggesting increased risk of trachoma for households at the fringes of communities. Targeting these isolated households with special programming along with dissemination through trusted social gathering facilities may improve effectiveness of current prevention efforts.

Remaining questions about clinical variola major.

After the recent summary of World Health Organization-authorized research on smallpox, several clinical issues remain. This policy review addresses whether early hemorrhagic smallpox is disseminated intravascular coagulation and speculates about the cause of the high mortality rate among pregnant women and whether ocular smallpox is partly the result of trachoma or vitamin A deficiency. The joint destruction common in children with smallpox might be prevented by antiviral drugs, but intraarticular infusion of antiviral drugs is unprecedented. Development of highly effective antiviral drugs against smallpox raises the issue of whether postexposure vaccination can be performed without interference by an antiviral drug. Clinicians should consider whether patients with smallpox should be admitted to general hospitals. Although an adequate supply of second-generation smallpox vaccine exists in the United States, its use is unclear. Finally, political and ethical forces suggest that destruction of the remaining stocks of live smallpox virus is now appropriate.

In vivo confocal microscopy of trachoma in relation to normal tarsal conjunctiva.

OBJECTIVE: To describe the in vivo confocal microscopy (IVCM) appearances of the tarsal conjunctiva in trachoma compared with the appearance of healthy conjunctiva and to develop grading systems for IVCM examination of the tarsal conjunctiva for use in future studies on trachoma and other conjunctival diseases. DESIGN: Prospective observational study. PARTICIPANTS: In vivo confocal microscopy examination was performed on 302 clinically normal adults, 16 clinically normal children, 750 adults with trachomatous conjunctival scarring, and 25 children with active trachoma. METHODS: Clinical evaluation was performed with ×2.5 loupes, and IVCM examination of the upper tarsal conjunctiva was carried out with a Heidelberg Retina Tomograph 3 with the Rostock Cornea Module (Heidelberg Engineering GmbH, Dossenheim, Germany). MAIN OUTCOME MEASURES: In vivo confocal microscopy images were analyzed for cellular and tissue changes associated with trachomatous inflammation and scarring compared with healthy subjects. RESULTS: Trachomatous subjects with follicular and papillary inflammation had an increased inflammatory cellular infiltrate, including dendritiform cells, discrete follicular and papillary structures, and cystic lacunae suggestive of tissue edema. Trachomatous conjunctival scarring was seen with IVCM as organization of the subepithelial connective tissue into bands/sheets. Grading systems for inflammatory changes and scarring were developed, with the system for scarring showing good interobserver agreement with an intraclass coefficient of 0.88. CONCLUSIONS: In vivo confocal microscopy provides a powerful tool for examining the ocular surface. Numerous cellular and tissue changes were observed in subjects with trachoma, the first time IVCM has been applied to this disease. These changes both complement and add to previous histologic analyses. In vivo confocal microscopy promises to provide new insights into the pathogenesis of trachoma and other conjunctival diseases.

Rates and risk factors for unfavorable outcomes 6 weeks after trichiasis surgery.

PURPOSE: Several studies of trichiasis recurrence suggest an association between surgical factors and long-term recurrence, yet data on short-term risk factors are limited. This study was conducted to evaluate risk factors for early trichiasis recurrence and other unfavorable short-term outcomes. METHODS: Trichiasis patients presenting for surgery were evaluated for presence of active trachoma and signs of cicatricial outcomes of trachoma, including number of trichiatic lashes, epilation, and entropion. Surgical factors recorded included incision length, surgery duration, and the surgeon performing the operation. Participants were followed up for 6 weeks after surgery and evaluated for eyelid closure defect and trichiasis recurrence; in addition, in two thirds of the patients, eyelid contour abnormality and granuloma formation were evaluated. RESULTS: First-time trichiasis surgery was performed on 2615 eyelids. Of these, 2601 eyelids without surgical failure were followed up 6 weeks after surgery. Of the eyelids treated, 2.3% had recurrent trichiasis and 1.3% had an eyelid closure defect. Data on eyelid contour abnormalities and granuloma formation were recorded for 1881 eyes, with rates of 1.2% and 10.5%, respectively. Associated risk factors differed by outcome. Surgeon was predictive of eyelid closure defect and granuloma formation. Eyelids with short incisions were nearly four times more likely to have recurrent trichiasis (95% confidence interval, 1.7-9.3). Baseline trichiasis severity was predictive of eyelid contour abnormalities and recurrent trichiasis. Epilation was associated with granuloma formation, but was protective against eyelid closure defect. CONCLUSIONS: Surgical factors are important predictors of unfavorable outcomes in the weeks immediately after surgery. Although the overall rate of serious uncorrectable unfavorable outcomes was very low, the high rate of granuloma formation, which can be treated by removal, highlights the need for follow-up of patients after trichiasis surgery. (ClinicalTrials.gov number, NCT00347776.).