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

Figures & data

FIGURE 1. Scale of the Global Trachoma Mapping Project.

TABLE 1. Working groups for the Global Trachoma Mapping Project.

Name of working group	Goals
Methodologies	(1) To produce guidelines for when to use each of the current protocols for determining the need for intervention against trachoma, i.e., (a) at district level (trachoma rapid assessment,39 population-based prevalence surveys,2 and    integrated threshold mapping19). (b) at larger-than-district level (trachoma rapid assessment,39 population-based prevalence    surveys,2 and integrated threshold mapping19). (2) To review current indicators and protocols for collecting data on water, sanitation and hygiene (WASH) variables, and see to what extent they could be practically integrated with the protocols considered in (1).
Prioritization	(1) Prioritize countries for baseline trachoma mapping. (2) Prioritize (in collaboration with in-country opinion leaders and other stakeholders) districts for baseline trachoma mapping within each country. (3) Identify opportunities to coordinate with other mapping efforts.
Tools	(1) Review available systems for data collection, validation, storage, analysis and sharing in projects originating with fieldwork conducted in rural communities of developing countries. (2) Recommend (to the Advisory Committee) the most appropriate systems for use in baseline trachoma mapping, bearing in mind the separate needs of mapping efforts that collect: (a) data relevant only to trachoma control, (b) data relevant to control of trachoma and other endemic diseases, and (c) data relevant to control of one or more endemic diseases and WASH programs.
Training	(1) Review current systems and materials for training teams to undertake protocols that estimate the need for intervention against trachoma, including those in which such estimates are collected at the same time as estimates of the prevalence of other endemic diseases and/or WASH variables. (2) Review current systems and materials for training the trainers who will train the teams described in (1), including materials to develop trainers' training skills. (3) Recommend (to the Advisory Committee) the most appropriate training methods for use in baseline trachoma mapping, bearing in mind the separate training needs of mapping efforts that collect: (a) data relevant only to trachoma control, (b) data relevant to control of trachoma and other endemic diseases, and (c) data relevant to control of one or more endemic diseases and WASH programs.

TABLE 2. Efforts to maximize government ownership within the Global Trachoma Mapping Project.

Domain	Approach to facilitate government ownership
Stakeholder engagement	Initial engagement with ministry of health is preferably made in conjunction with a non-governmental organization already collaborating with the ministry.
Field team composition	Grader and recorder trainees are selected, recruited and contracted by the ministry of health.
Field team training	Field team training is conducted under the auspices of the ministry of health, using (as far as is practical) national trainers.
Capacity building	Ministry of health staff draft the evaluation unit divisions, cluster list and fieldwork protocol, which is then refined and finalized in discussion with Global Trachoma Mapping Project epidemiologists to ensure international standardization. The ministry of health appoints a lead author to draft a paper presenting the project results for publication in a peer-reviewed journal.
Data management	Although (in order to ensure international standardization) data cleaning is undertaken by a single data manager who works across all projects, the adequacy of data collection and data cleaning process must be approved by a designated ministry of health official before analysis. Prevalence estimates must be approved by a designated ministry of health official before they are considered finalized. Only the ministry of health has access to download the full datasets. Only prevalence categories (not the estimates themselves) are released to the Global Atlas of Trachoma, and only after ministry of health approval. The ministry of health is free to share data with its partners at any time.

FIGURE 2. Selection criteria for Global Trachoma Mapping Project (GTMP) field team trainees.15

TABLE 3. Water, sanitation and hygiene data collected at each household included in surveys for the Global Trachoma Mapping Project,.

Question	Possible responses
In the dry season, what is the main source of drinking water for members of your household?	01 = Piped water into dwelling 02 = Piped water to yard/plot 03 = Public tap/standpipe 04 = Tubewell/borehole 05 = Protected dug well 06 = Unprotected dug well 07 = Protected spring 08 = Unprotected spring 09 = Rainwater collection 10 = Water vendor 11 = Surface water (e.g. river, dam, lake, canal) 99 = Other (specify)
How long does it take to go there, get water, and come back?	1 = Water source in the yard 2 = Less than 30 minutes 3 = Between 30 minutes and 1 hour 4 = More than 1 hour
In the dry season, what is the main source of water used by your household for washing faces?	01 = Piped water into dwelling 02 = Piped water to yard/plot 03 = Public tap/standpipe 04 = Tubewell/borehole 05 = Protected dug well 06 = Unprotected dug well 07 = Protected spring 08 = Unprotected spring 09 = Rainwater collection 10 = Water vendor 11 = Surface water (e.g. river, dam, lake, canal) 99 = Other (specify)
If you collected water there to bring back to the house, how long would it take to go there, get water, and come back?	0 = All face washing done at water source 1 = Water source in the yard 2 = Less than 30 minutes 3 = Between 30 minutes and 1 hour 4 = More than 1 hour
Where do you and other adults in the household usually defecate?	1 = Shared or public latrine 2 = Private latrine 3 = No structure, outside near the house 4 = No structure, in the bush or field 9 = Other
Ask to see the latrine/toilet. Observation: What kind of toilet facility do the adults in the household use?	01 = Flush/pour flush to piped sewer system 02 = Flush/pour flush to septic tank 03 = Flush/pour flush to pit latrine 04 = Flush/pour flush to open drains 05 = Flush/pour flush to unknown place 06 = Ventilated improved pit latrine 07 = Pit latrine with slab 08 = Pit latrine without slab/open pit 09 = Composting toilet 10 = Bucket 11 = Hanging toilet/hanging latrine 12 = No facilities or bush or field 99 = Other (specify)
Observation: Is there a handwashing facility within 15 m of the latrine/toilet?	0 = No 1 = Yes 5 = Not applicable (no latrine/toilet)
Observation: At the time of the visit, is water available at the handwashing facility?	0 = No 1 = Yes 5 = Not applicable (no handwashing facility)
Observation: At the time of the visit, is soap or ash available at the handwashing facility?	0 = No 1 = Yes 5 = Not applicable (no handwashing facility)

FIGURE 3. Global Trachoma Mapping Project (GTMP) data handling and flow. (1) The field team upload the raw data, which are available for review and download by designated ministry of health (MOH) personnel. (2) The GTMP Data Manager cleans the raw data by checking for and querying (with the field team) any errors, internal inconsistencies or missing data. (3) A designated MOH official evaluates the cleaned dataset, and then either approves it (“approval C”) or queries it; once approved, analyses to generate evaluation unit-level prevalences are run automatically. (4) A designated MOH official evaluates the prevalence figures and either approves them (“approval P”) or queries them. (5) Once approved, categorical prevalence data are uploaded to the Global Atlas of Trachoma (GAT).

Negrel AD, Taylor HR, West S. Guidelines for the rapid assessment for blinding trachoma (WHO/PBD/GET/00.8). Geneva: World Health Organization, 2001

 Google Scholar

Solomon AW, Zondervan M, Kuper H, et al. Trachoma control: a guide for program managers. Geneva: World Health Organization, 2006

 Google Scholar

Dorkenoo AM, Bronzan RN, Ayena KD, et al. Nationwide integrated mapping of three neglected tropical diseases in Togo: countrywide implementation of a novel approach. Trop Med Int Health 2012;17:896–903

 PubMed Web of Science ®Google Scholar

Courtright P, Gass K, Lewallen S, et al. Global trachoma mapping project: training for mapping of trachoma (version 2) [Available at: http://www.trachomacoalition.org/resources/global-trachoma-mapping-project-training-mapping-trachoma]. London: International Coalition for Trachoma Control, 2013

 Google Scholar