Impact Survey Results after SAFE Strategy Implementation in 15 Local Government Areas of Kebbi, Sokoto and Zamfara States, Nigeria

Figures & data

Figure 2. Local government areas for trachoma impact surveys, Kebbi, Sokoto and Zamfara States, Nigeria, 2014–2016.

Table 1. Results of 15 selected baseline trachoma prevalence surveys conducted from 2004 to 2006, and consequent public health-level actions, Kebbi, Sokoto and Zamfara States, Nigeria^{14,15,unpublished data}.

State	Local government area	Year of baseline survey	Trichiasis prevalence (≥15 years old, %)^a	Action (S)	TF prevalence (1–9 years old, %)^a	Action (A, F, E)
Kebbi	Arewa	2004	1.0	2390	13.6	3 years MDA, BCC
	Argungu	2004	1.8	2415	16.3	3 years MDA, BCC
	Augie	2004	0.9	1675	21.3	3 years MDA, BCC
Sokoto	Binji	2006	2.1	413	29	3 years MDA, BCC
	Gada	2004	3.1	1632	29.1	3 years MDA, BCC
	Goronyo	2004	5.9	1290	26.8	3 years MDA, BCC
	Gwadabawa	2006	4.0	927	49	5 years MDA, BCC
	Illela	2004	3.1	1309	29.7	3 years MDA, BCC
	Isa	2004	2.9	2163	13.5	3 years MDA, BCC
	Kware	2006	5.6	666	43	5 years MDA, BCC
	Rabah	2004	2.8	1339	21.4	3 years MDA, BCC
	Tangaza	2004	2.7	1431	21.4	3 years MDA, BCC
Zamfara	Birnin Magaji	2004	1.4	696	32.1	5 years MDA, BCC
	Shinkafi	2004	1.2	803	17.9	3 years MDA, BCC
	Zurmi	2004	1.1	711	22.7	3 years MDA, BCC

^a Unadjusted.

A = antibiotics; BCC = behaviour change communication; F = facial cleanliness; E = environmental improvement; MDA = mass drug administration; S = surgery; TF = trachomatous inflammation—follicular; TT = trachomatous trichiasis.

Figure 1. Number of rounds of antibiotic mass drug administration (MDA) for trachoma, Kebbi, Sokoto and Zamfara States, Nigeria, 2010–2013.

Table 2. Enumeration and examination characteristics of sampled individuals in 15 local government areas, impact surveys for trachoma, Kebbi, Sokoto and Zamfara States, Nigeria, 2014–2016.

State	Local government area	Households surveyed	Persons enumerated			Persons examined, n (%)		Persons absent		Persons refusing examination
			Total	1-9-year-olds	≥15-year-olds	1-9-year-olds	≥15-year-olds	1-9-year-olds	≥15-year-olds	1-9-year-olds	≥15-year-olds
Kebbi	Argungu	765	4620	1754	2304	1651 (94)	1880 (82)	52	362	51	62
	Augie	745	4388	1892	2057	1853 (98)	1861 (90)	22	179	17	16
	Arewa	2488	13,606	5642	6733	5283 (94)	5672 (84)	190	895	169	166
Sokoto	Gada	625	3385	1462	1589	1375 (94)	1294 (81)	39	146	47	148
	Gwadabawa	726	3538	1458	1790	1370 (94)	1272 (71)	44	397	44	121
	Kware	623	2698	956	1511	921 (96)	1388 (92)	7	110	28	13
	Binji	625	3147	1275	1543	1246 (98)	1359 (88)	11	90	18	94
	Goronyo	624	3694	1655	1622	1537 (93)	1239 (76)	72	175	46	208
	Illela	624	3189	1300	1578	1255 (97)	1340 (85)	19	136	26	102
	Isa	624	3598	1449	1690	1374 (95)	1314 (78)	43	213	32	162
	Rabah	626	3368	1374	1598	1288 (94)	1205 (75)	50	184	36	208
	Tangaza	623	3210	1300	1539	1241 (95)	1318 (86)	20	126	39	95
Zamfara	Birnin Magaji^a	624	3701	1547	1814	1400 (90)	1537 (85)	88	233	59	44
	Shinkafi	897	4285	1799	2120	1772 (98)	1828 (86)	12	221	15	71
	Zurmi	895	5092	1927	2646	1792 (93)	2259 (85)	74	377	61	10

^a Second impact survey (2016).

Table 3. Prevalence of trachomatous inflammation—follicular (TF) and trichiasis or trachomatous trichiasis (TT) at baseline and impact surveys, 15 local government areas of Kebbi, Sokoto and Zamfara States, Nigeria.

			Baseline survey data						Impact survey data
State	Local government area	Population	Year	Trichiasis^a prevalence in ≥15-year-olds, % [95% confidence interval]	Estimated TT backlog	TF prevalence in 1-9-year-olds, % [95% confidence interval]	Number of people operated for TT	Rounds of MDA	Year	TT prevalence in ≥15-year-olds, % [95% confidence interval]	TF prevalence in 1-9-year-olds (%) [95% confidence interval]
Kebbi	Argungu	200,248	2004	1.8 [0.5–3.1]	2018	16.3 [12.6–20.0]	2415	3	2014	0.05 [0.00–0.14]	2.8 [1.7–4.3]
	Augie	116,368	2004	0.9 [0–1.8]	586	21.3 [17.1–25.5]	1675	3	2014	0.26 [0.07–0.48]	6.7 [4.1–10.0]
	Arewa	198,728	2004	1.0 [0.1–1.9]	1113	13.6 [10.2–17.0]	2390	3	2014	0.77 [0.51–1.10]	4.3 [3.3–5.4]
Sokoto	Gada	249,051	2004	3.1 [1.6–4.6]	4324	29.1 [24.7–33.5]	1632	3	2016	0.1 [0.0–0.3]	9.7 [6.5–13.5]
	Gwadabawa	231,569	2006	4.0 [2.5–6.3]	5187	49 [42.9–55.1]	927	5	2014	0.03 [0.00–0.08]	4.2 [2.2–7.1]
	Kware	134,084	2006	5.6 [3.2–8.0]	4205	43 [36.9–49.1]	666	1	2014	0.3 [0.1–0.4]	2.2 [0.7–2.9]
	Binji	104,274	2006	2.1 [0.6–3.6]	1226	29 [23.4–3.6]	413	3	2016	0.4 [0.0–0.9]	5.9 [4.1–7.9]
	Goronyo	182,118	2004	5.9 [3.8–8.0]	6017	26.8 [22.5–31.1]	1290	3	2016	0.03 [0.0–0.1]	7 [4.8–9.1]
	Illela	150,133	2004	3.1 [1.6–4.6]	2606	29.7 [25.4–34.0]	1309	3	2016	0.04 [0.0–0.09]	10.3 [7.2–14.3]
	Isa	150,268	2004	2.9 [1.5–4.3]	2440	13.5 [10.2–16.8]	2163	3	2016	0.04 [0.0–0.12]	5.4 [3.7–7.7]
	Rabah	149,152	2004	2.8 [1.4–4.2]	2339	21.4 [17.5–25.3]	1339	3	2016	0	3.8 [1.5–5.7]
	Tangaza	114,770	2004	2.7 [1.3–4.1]	1735	21.4 [17.5–25.4]	1431	3	2016	0.1 [0.0–0.28]	6.5 [4.3–9.3]
Zamfara	Birnin Magaji^b	184,083	2004	1.4 [0.4–2.4]	1443	32.1 [27.6–36.6]	696	4	2016	0.22 [0.07–0.43]	1.7 [1.1–2.3]
	Shinkafi	135,964	2004	1.2 [0.25–2.15]	914	17.9 [14.1–21.6]	803	3	2015	0.01 [0.00–0.04]	1.4 [0.5–2.9]
	Zurmi	293,977	2004	1.1 [0.2–1.9]	1811	22.7 [18.7–26.7]	711	3	2015	0.18 [0.03–0.38]	1.2 [0.6–2.1]

^a Baseline surveys were conducted by other investigators; for many of these surveys, fieldwork and analysis protocols could not be located. Baseline survey data have been provided as reported, and only as a comparator for our impact survey data. We assume, based on then-current practice that the presence of TS was not required for “trachomatous trichiasis” to be diagnosed at baseline, even though the survey reports refer to prevalence estimates of “trachomatous trichiasis”.

^b Second impact survey (2016).

Table 4. Prevalence of trachomatous inflammation—follicular (TF) and trachomatous trichiasis (TT), impact surveys, four sub-districts of Arewa local government area, Kebbi State, Nigeria, 2014.

		1-9-year-olds					≥15-year-olds
Sub- district	Number of households sampled	Residents enumerated	Residents examined	Absent	Refused	TF prevalence^a (95% CI)	Residents enumerated	Residents examined	Absent	Refused	TT prevalence^b (95% CI)
1	595	1406	1271	48	87	5.1 (2.6–8.2)	1645	1438	183	22	1.1 (0.6–1.6)
2	599	1266	1202	27	37	4.1 (2.2–5.9)	1564	1326	191	46	1.0 (0.5–1.5)
3	648	1450	1365	68	16	2.2 (1.2–3.4)	1686	1408	262	16	0.6 (0.1–1.4)
4	646	1520	1445	47	28	5.7 (3.6–8.4)	1838	1500	259	79	0.5 (0.1–1.1)

^a Adjusted for age in 1-year age bands.

^b Adjusted for gender and age in 5-year age bands.

CI = confidence interval.

Table 5. Number of individuals with trichiasis, number of individuals with trichiasis + trachomatous conjunctival scarring (a combination referred to here as trachomatous trichiasis, TT: see text) and prevalence of each of these things, impact surveys, 15 local government areas (LGAs) of Kebbi, Sokoto and Zamfara States, Nigeria, 2014–2016.

State	LGA	Number of ≥15-year-olds with trichiasis	Trichiasis prevalence in ≥15-year-olds, % (95% confidence interval)	Number of ≥15-year-olds with TT	TT prevalence in ≥15-year-olds, % (95% confidence interval)
Kebbi	Argungu	13	0.53 (0.11–1.23)	3	0.05 (0.00–0.14)
	Augie	17	0.49 (0.19–0.86)	9	0.26 (0.07–0.48)
	Arewa	17	0.77 (0.52–1.09)	9	0.77 (0.51–1.10)
Sokoto	Gada	8	0.99 (0.35–1.79)	3	0.1 (0.0–0.3)
	Gwadabawa	16	0.82 (0,45–1.28)	10	0.03 (0.00–0.08)
	Kware	8	0.26 (0.11–0.42)	8	0.3 (0.1–0.4)
	Binji	22	1.83 (0.87–3.22)	8	0.4 (0.0–0.9)
	Goronyo	13	0.70 (0.16–1.64)	1	0.03 (0.0–0.1)
	Illela	16	0.68 (0.27–1.23)	2	0.04 (0.0–0.09)
	Isa	9	0.36 (0.11–0.75)	2	0.04 (0.0–0.12)
	Rabah	4	0.20 (0.03–0.48)	0	0
	Tangaza	8	0.22 (0.05–0.48)	4	0.1 (0.0–0.28)
Zamfara	Birnin Magaji	10	0.30 (013–0.51)	7	0.22(0.07–0.43)
	Shinkafi	4	0.09 (0.01–0.19)	1	0.01 (0.00–0.04)
	Zurmi	9	0.22 (0.06–0.42)	6	0.18 (0.03–0.38)

Table 6. Household access to water and improved sanitation facilities, 15 local government areas of Kebbi, Sokoto and Zamfara States, Nigeria, 2014–2016.

State	Local government area	Access to a water source for washing within 1 km of the household, %	Access to an improved water source, %	Access to an improved sanitation facility, %
Kebbi	Argungu	96	72	42
	Augie	88	33	12
	Arewa	82	53	10
Sokoto	Gada	54	33	17
	Gwadabawa	62	17	16
	Kware	71	28	24
	Binji	90	7	11
	Goronyo	74	30	29
	Illela	81	8	20
	Isa	85	44	34
	Rabah	65	21	28
	Tangaza	89	2	22
Zamfara	Birnin Magajia	89	79	59
	Shinkafi	67	58	25
	Zurmi	49	53	19

^a Second impact survey (2016).

Muhammad N, Rabiu MM. Prevalence of Trachoma in 6 Local Government Areas of Kebbi State [Paper Presented at the Annual Conference of the Ophthalmological Society of Nigeria]. Kaduna: National Eye Centre; 2006.

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Rabiu MM, Muhammad N. Report of Trachoma Population Based Survey in 6 Local Government Areas of Zamfara State. Kaduna: Sightsavers International; 2005.

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