Baseline Prevalence of Trachoma in 13 Local Government Areas of Borno State, Nigeria

ABSTRACT

Purpose

We set out to determine the baseline prevalence of trachoma in 13 Local Government Areas (LGAs) of Borno State, Nigeria.

Methods

A population-based cross-sectional survey was conducted in each of 13 LGAs from 2017 to 2019, with the support of Tropical Data (TD). World Health Organization (WHO)-recommended protocols were used. With a probability-proportional-to-size systematic sampling method, 25 villages were selected per LGA in 2017 and 30 villages per LGA in 2019; in each village, 25 households were enrolled for 2017 surveys, while 30 were enrolled for 2019 surveys. All present, consenting residents aged ≥1 year were examined by TD-certified graders for trachomatous inflammation—follicular (TF) and trachomatous trichiasis (TT) using the WHO simplified grading scheme. Additionally, we collected data on household-level access to water, sanitation and hygiene (WASH) facilities.

Results

One LGA (Magumeri) had TF prevalence in 1–9-year-olds ≥10%; two other LGAs (Monguno and Kaga) had TF prevalence between 5.0% and 9.9%. The prevalence of TT unknown to the health system was ≥0.2% in six LGAs. The proportion of households with access to improved water sources ranged from 30% (Kwaya Kusar) to 95% (Monguno); household-level access to improved latrines was lowest in Shani (7%) and highest in Maiduguri (95%).

Conclusion

Active TT case finding and strengthening of TT surgical services are needed in six LGAs. Mass drug administration (MDA) of antibiotics is needed in three LGAs to reduce the prevalence of active trachoma to below elimination thresholds. The trachoma elimination programme should engage WASH agencies to augment access to improved WASH facilities.

KEYWORDS:

• Nigeria
• Borno
• trachoma
• trichiasis
• prevalence
• Tropical Data
• WASH

Acknowledgments

We thank the staff of Borno State Ministry of Health and the security agencies for their kind collaboration; in-country Tropical Data trainers, our hard-working field teams; staff of supporting non-governmental development organisations, the wider Tropical Data team, and the residents of participating communities. We are grateful to Robert Butcher for his invaluable comments on the first draft of this manuscript.

Disclosure statement

The authors alone are responsible for the content and writing of the paper. RW and AB were 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 declare no conflicts 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

Surveys were funded by the UK aid via Sightsavers to support the Nigeria National Trachoma Elimination Programme and managed in Borno State by Helen Keller International through a sub-grant from 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.