Prevalence of Trachoma following Implementation of the SAFE Strategy in Three Local Government Areas of Taraba State, North Eastern Nigeria

ABSTRACT

Introduction

In 2019–2020, one round of antibiotic mass drug administration (MDA) was implemented for trachoma elimination purposes in Donga, Gashaka, and Ussa local government areas (LGAs) of Taraba State, Nigeria, following baseline surveys in 2009 (Donga and Gashaka) and 2013–2014 (Ussa). Here, trachoma prevalence post-MDA in these three LGAs is reported.

Methods

In 2019 (Gashaka and Ussa) and 2020 (Donga), population-based, cross-sectional surveys were conducted following World Health Organization (WHO) guidance. A two-stage cluster sampling strategy was used. All residents of selected households aged ≥1 year were examined by Tropical Data-certified graders for trachomatous inflammation—follicular (TF) and trachomatous trichiasis (TT) using the WHO simplified trachoma grading scheme. Data on water, sanitation, and hygiene (WASH) access were also collected.

Results

A total of 1,883 households participated. From these households, 4,885 children aged 1–9 years were enumerated, and 4,866 (99.6%) examined. There were 5,050 eligible adults (aged ≥15 years) enumerated in the same households, of whom 4,888 (96.8%) were examined. Age-adjusted TF prevalence in children aged 1–9 years was 0.22% (95% CI: 0.00–0.65) in Donga, 0.0% in Gashaka, and 0.19% (95% CI: 0.00–0.44) in Ussa. The age- and gender-adjusted TT prevalence unknown to the health system in adults aged ≥15 years was 0.08% (95% CI: 0.00–0.19) in Donga, 0.02% (95% CI: 0.00–0.06) in Gashaka, and 0.10% (95% CI: 0.01–0.18) in Ussa. In Donga, Gashaka, and Ussa, respectively, 66%, 49% and 63% of households had access to an improved drinking water source, and 68%, 56% and 29% had access to an improved latrine.

Conclusion

In all LGAs, the elimination thresholds for TF and TT unknown to the health system have been attained in the target age groups. These LGAs should be re-surveyed after 2 years to show that reductions in TF prevalence have been sustained in the absence of MDA. Health authorities should continue to improve WASH facilities to reduce the risk of later recrudescence.

KEYWORDS:

• Trachoma
• trichiasis
• prevalence survey
• Nigeria
• taraba
• tropical data
• WASH

Acknowledgments

We thank Sightsavers for funding implementation of the SAFE strategy in Taraba, the impact surveys described herein, and its ongoing collaboration in the effort towards the elimination of trachoma in Nigeria. We are grateful to the residents and leaders of surveyed communities for their trust and enthusiastic participation. We also appreciate the input of Robert Butcher on the first draft of this manuscript. AB and SB 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. AWS is a staff member of the World Health Organization.

Disclosure statement

SB and AB are employed by the International Trachoma Initiative at The Task Force for Global Health, which receives an operating budget and research fund from Pfizer Inc., the manufacturers of Zithromax (Azithromycin). EMHE receives salary support from the International Trachoma Initiative. The authors declare no conflict of interest.

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.

Additional information

Funding

Field work for these surveys were provided by Sightsavers. 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.