Prevalence of Trachoma in 72 Districts of Afghanistan in 2018−2019: Results of 35 Population-based Prevalence Surveys

ABSTRACT

Background

To determine where interventions are needed to eliminate trachoma as a public health problem, prevalence data are needed. We aimed to generate baseline population-based data on trachoma prevalence in suspected-endemic areas of Afghanistan.

Methods

Cross-sectional population-based prevalence surveys designed according to World Health Organization (WHO) recommendations were conducted in 35 evaluation units (EUs) covering 72 districts. In selected households, all resident individuals aged ≥1 year were examined for trachomatous inflammation—follicular (TF) and trachomatous trichiasis (TT) according to the WHO simplified trachoma grading system. Water, sanitation and hygiene access was assessed in households of survey participants.

Results

104,104 people aged ≥1 year were examined, including 43,774 children aged 1–9 years and 46,439 people aged ≥15 years. The age-adjusted prevalence of TF in 1–9-year-olds was ≥5% in 3 EUs, with the highest EU TF prevalence being 7.8%. The age- and gender-adjusted prevalence of TT unknown to the health system in ≥15-year-olds was <0.2% in all EUs. The majority of households had access to an improved water source within 30 minutes of the house. However, only a minority of households had an improved latrine and/or a handwash station.

Conclusions

Trachoma is not a public health problem in the majority of EUs surveyed. However, antibiotic mass drug administration, promotion of facial cleanliness and environmental improvement (the A, F and E components of the SAFE strategy) are needed for trachoma elimination purposes in three of the EUs surveyed in Afghanistan.

Keywords:

• Trachoma; Afghanistan; blindness; neglected tropical diseases; prevalence

Disclosure statement

“AB, RW and KR are employed by the International Trachoma Initiative at The Task Force for Global Health, which receives an operating budget and research funds from Pfizer Inc., the manufacturers of Zithromax® (azithromycin). EMHE receives salary support from the International Trachoma Initiative.The other authors have no conflicting interests to declare.”

Disclaimer

The authors alone are responsible for the views expressed in this article and they do not necessarily represent the views, decisions or policies of the institutions with which they are affiliated, USAID or the United States Government.

Supplementary material

Supplemental data for this article can be accessed on the publisher’s website.

Additional information

Funding

These surveys and the salaries of RB and AH were funded by the Fred Hollows Foundation. Core Tropical Data funding was provided by the International Trachoma Initiative; Sightsavers; and RTI International through the United States Agency for International Development (USAID) Act to End NTDs | East program. AWS is a staff member of the World Health Organization.