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Original Articles

The Global Trachoma Mapping Project: Methodology of a 34-Country Population-Based Study

Anthony W. SolomonFaculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK, ;London Centre for Neglected Tropical Disease Research, London, UK, Correspondence[email protected]

Alexandre L. PavluckInternational Trachoma Initiative, The Task Force for Global Health, Decatur, GA, USA,

Paul CourtrightKilimanjaro Centre for Community Ophthalmology, Division of Ophthalmology, University of Cape Town, Cape Town, South Africa,

Agatha AboeSightsavers, Airport Residential Area, Accra, Ghana,

Liknaw AdamuCommunity Eye Health Consultancy, Addis Ababa, Ethiopia,

Wondu AlemayehuThe Fred Hollows Foundation Ethiopia, Addis Ababa, Ethiopia, ;Berhan Public Health and Eye Care Consultancy, Addis Adaba, Ethiopia,

Menbere AlemuInternational Trachoma Initiative Ethiopia Office, Wollo Sefer, Addis Ababa, Ethiopia,

Neal D. E. AlexanderMRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK,

Amir Bedri KelloLight for the World, Addis Ababa, Ethiopia,

Berhanu BeroInternational Trachoma Initiative Ethiopia Office, Wollo Sefer, Addis Ababa, Ethiopia,

Simon J. BrookerFaculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK, ;London Centre for Neglected Tropical Disease Research, London, UK,

Brian K. ChuInternational Trachoma Initiative, The Task Force for Global Health, Decatur, GA, USA,

Michael DejeneMichael Dejene Public Health Consultancy Services, Addis Ababa, Ethiopia,

Paul M. EmersonThe Carter Center, Atlanta, GA, USA,

Rebecca M. FlueckigerInternational Trachoma Initiative, The Task Force for Global Health, Decatur, GA, USA,

Solomon GadisaOromia Regional Health Bureau, Addis Ababa, Ethiopia,

Katherine GassInternational Trachoma Initiative, The Task Force for Global Health, Decatur, GA, USA,

Teshome GebreInternational Trachoma Initiative Regional Office for Africa, Wollo Sefer, Addis Ababa, Ethiopia,

Zelalem HabtamuOromia Regional Health Bureau, Addis Ababa, Ethiopia,

Erik HarveyWater Aid, London, UK,

Dominic HaslamSightsavers, Haywards Heath, West Sussex, UK,

Jonathan D. KingThe Carter Center, Atlanta, GA, USA,

Richard Le MesurierThe Fred Hollows Foundation, Rosebery NSW, Australia,

Susan LewallenKilimanjaro Centre for Community Ophthalmology, Division of Ophthalmology, University of Cape Town, Cape Town, South Africa,

Thomas M. LietmanFrancis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA,

Chad MacArthurHelen Keller International, New York, NY, USA,

Silvio P. MariottiPrevention of Blindness and Deafness, World Health Organization, Geneva, Switzerland,

Anna MasseySightsavers, Haywards Heath, West Sussex, UK,

Els MathieuCenters for Disease Control and Prevention, Atlanta, GA, USA,

Addis MekashaOromia Regional Health Bureau, Addis Ababa, Ethiopia,

Tom MillarSightsavers, Haywards Heath, West Sussex, UK,

Caleb MpyetSightsavers Nigeria, Kaduna, Nigeria, ;Department of Ophthalmology, Jos University, Jos, Nigeria,

Beatriz E. MuñozDana Center for Preventive Ophthalmology, The Wilmer Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA,

Jeremiah NgondiThe Carter Center, Atlanta, GA, USA,

Stephanie OgdenInternational Trachoma Initiative, The Task Force for Global Health, Decatur, GA, USA,

Joseph PearceWater Aid, London, UK,

Virginia SarahThe Fred Hollows Foundation, Rosebery NSW, Australia,

Alemayehu SisayORBIS International – Ethiopia, Addis Ababa, Ethiopia,

Jennifer L. SmithFaculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK, ;London Centre for Neglected Tropical Disease Research, London, UK,

Hugh R. TaylorMelbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia, and

Jo ThomsonThe Fred Hollows Foundation, Rosebery NSW, Australia,

Sheila K. WestDana Center for Preventive Ophthalmology, The Wilmer Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA,

Rebecca WillisInternational Trachoma Initiative, The Task Force for Global Health, Decatur, GA, USA,

Simon BushSightsavers, Airport Residential Area, Accra, Ghana,

Danny HaddadInternational Trachoma Initiative, The Task Force for Global Health, Decatur, GA, USA, ;Emory Eye Center, Atlanta, GA, USA

Allen FosterFaculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK,

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ABSTRACT

Purpose: To complete the baseline trachoma map worldwide by conducting population-based surveys in an estimated 1238 suspected endemic districts of 34 countries.

Methods: A series of national and sub-national projects owned, managed and staffed by ministries of health, conduct house-to-house cluster random sample surveys in evaluation units, which generally correspond to “health district” size: populations of 100,000–250,000 people. In each evaluation unit, we invite all residents aged 1 year and older from h households in each of c clusters to be examined for clinical signs of trachoma, where h is the number of households that can be seen by 1 team in 1 day, and the product h × c is calculated to facilitate recruitment of 1019 children aged 1–9 years. In addition to individual-level demographic and clinical data, household-level water, sanitation and hygiene data are entered into the purpose-built LINKS application on Android smartphones, transmitted to the Cloud, and cleaned, analyzed and ministry-of-health-approved via a secure web-based portal. The main outcome measures are the evaluation unit-level prevalence of follicular trachoma in children aged 1–9 years, prevalence of trachomatous trichiasis in adults aged 15 + years, percentage of households using safe methods for disposal of human feces, and percentage of households with proximate access to water for personal hygiene purposes.

Results: In the first year of fieldwork, 347 field teams commenced work in 21 projects in 7 countries.

Conclusion: With an approach that is innovative in design and scale, we aim to complete baseline mapping of trachoma throughout the world in 2015.

Keywords

DECLARATION OF INTEREST

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

The GTMP is funded by a grant from the United Kingdom's Department for International Development (DFID)(ARIES: 203145) to Sightsavers, who is leading a consortium of non-governmental organizations and academic institutions to complete the work described. Additional funding for fieldwork is provided by the United States Agency for International Development through its END in Asia grant to FHI 360; and its ENVISION grant to Sightsavers. The Committee established in March 2012 to examine issues surrounding completion of global trachoma mapping was initially supported by the International Trachoma Initiative, who receive funding from Pfizer. AWS was a Wellcome Trust Intermediate Clinical Fellow (098521) and SJB a Wellcome Trust Senior Research Fellow (098045) at the London School of Hygiene & Tropical Medicine. None of the funders had any role in study design, in study implementation or analysis or interpretation of data, in the decisions on where, how or when to publish in the peer reviewed press, or in preparation of the manuscript.

The Global Trachoma Mapping Project: Methodology of a 34-Country Population-Based Study

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The Global Trachoma Mapping Project: Methodology of a 34-Country Population-Based Study

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