Travel and Implications for the Elimination of Trachoma in Ethiopia

Abstract

Purpose: Trachoma is the leading infectious cause of blindness. The World Health Organization has set a goal of reducing the trachoma disease burden to a level where it is no longer a public health concern by the year 2020. Some investigators feel that local elimination of ocular chlamydia infection is possible, but little has been done to study the likelihood of reintroduction of infection from neighboring areas. Mass administration of azithromycin has been shown to dramatically reduce the prevalence of infection in many villages in central Ethiopia. However, after treatment is discontinued, infection returns. Reintroduction of infection could occur from the few remaining infected cases in a treated community or from outside the community. People traveling between villages might be responsible thus complicating the elimination of trachoma.

Methods: We conducted a survey to assess the travel pattern of the Gurage zone residents in Ethiopia. Seven hundred and seventeen households with at least one child aged 1–5 years in 48 villages were surveyed to collect the details of travel in 1 month prior to the survey.

Results: Seventy-eight percent of the surveyed households had at least one traveler, with the majority being women. Pre-school children, the main reservoir of clinically active infection, rarely traveled. Most travel was to the market or to school, and most for less than 1 day.

Conclusions: Travel routinely takes place in these villages. Trachoma control programs in this area might consider treating areas with the same markets and schools in the same period to increase the efficacy of mass treatment.

KEYWORDS::

• Chlamydia
• Elimination
• Survey
• Trachoma
• Travel
• Village

ACKNOWLEDGMENTS

We would like to thank the International Trachoma Initiative/Pfizer, the Bernard Osher Foundation, the South Asia Research Fund, Research to Prevent Blindness, That Man May See, and the National Institute of Health (Grant U10-EY016214) for financial support. We would also like to thank the Ethiopian Ministry of Health, and all the individuals who consented to participate in the survey.

Declaration of Interest: The authors have no conflict of interest with respect to the funding sources.