Discrepancies in trachoma control policies and practices in the last decade
Abstract
Purpose: To establish the discrepancies in trachoma control policies and practices since 2004
Introduction: The World Health Organisation (WHO) endorses clinical grading for trachoma
surveys and SAFE strategy for control: Surgery for trachomatous trichiasis (TT), Antibiotics
to treat infection and Facial cleanliness and Environmental changes to stop transmission.
Method: Trachoma control guidelines and practices were reviewed. Between 2004 and 2010,
interventions were conducted in administrative districts. In 2010, Kenya initiated surveys and
interventions in areas (trachoma districts) with 100,000 – 200,000 people each to standardise
the intervention units. Later, the WHO recommended impact assessments to be conducted in
areas with 100,000-250,000 each. SAFE is implemented where baseline prevalence of active
trachoma in children 1-9 years old is >10%. The lower age limit for surveys and monitoring of
TT surgical services varies in different countries. Surgical services are justified where baseline
prevalence of TT in persons aged 15+ years old is ≤1%. In 2014, the Global Trachoma Mapping
Project (GTMP) introduced new guidelines where TT surveys participants are to be recruited
exclusively in households sampled for active trachoma survey.
Results: District-based project planning is convenient due to existing administrative structures
but trachoma is more of a “community disease” than a “district level disease”. As a result, nonendemic
communities in large meso-endemic districts (population >200,000 people) were
included in mass drug administration (MDA). Also, “hot-spots” in large hypo-endemic districts
missed due to widely scattered survey clusters. This triggered the adoption of a new in survey
method in 2010. Microbiology tests to verify presence of chlamydial infection and assess drug
resistance are not done due to cost and logistics. Prevalence of TT in persons aged 15+ years
is usually low and survey sample sizes are big. Researchers adjust TT survey age limit and
precision to suit available funds. The GTMP method is convenient but may under-estimate the
prevalence since adults with children aged 1-9 years are relatively young while the prevalence
increases with advancing age. Results from different surveys will not be directly comparable
since the GTMP does not specify the sample size and precision for TT surveys. Moreover,
GTM puts emphasis is on SA. Kenya prefers comprehensive surveys to assessment all the
components of SAFE. In the last decade, FE components have been perpetually under-funded.
Conclusions: Trachoma policy reviews are influenced by evidence, economic considerations
and convenience. FE and trachoma microbiology are vital but ignored. Global trachoma
policies should be adopted to accommodate national programme needs.
Citation
Karimurio J. "discrepancies in trachoma control policies and practices in the last decade.". In: 8th annual neglected tropical diseases (ntd) conference. Kisumu, Kenya; 2014.Publisher
University of Nairobi